Polyuria following an overdose
A 42-year-old man with a known psychiatric history was admitted in the morning to ITU for respiratory and circulatory support following a mixed overdose. He had taken 50 mg of ramipril, 150 mg of olanzapine, and 200 mg of citalopram. He had taken no alcohol, paracetamol, aspirin, or recreational drugs and had not suffered any head injury.\nOn ITU he was sedated with 120 mg/h infusion of propofol 1%.\nIn the afternoon, he was noted to be polyuric with a urine output greater than 500 ml/h and his urine was noted to be progressively more dilute [].\nUrine and serum osmolarity were measured. Urine osmolarity was 160 mosmol/L (normal range 300–1000), serum osmolarity was 304 mosmol/L (normal range 280–300), demonstrating inappropriately dilute urine production. His blood glucose level was normal.\nHe was given intravenous fluid to replace urinary losses and was monitored. The following morning, sedation was stopped and he was extubated successfully. Shortly thereafter, urine concentration returned to normal.