A 48-year-old woman on lithium for bipolar I disorder is found to have a serum lithium level of 1.1 mEq/L (therapeutic range 0.6–1.2 mEq/L) but presents with coarse tremor, polyuria, and polydipsia. Which finding best distinguishes nephrogenic diabetes insipidus caused by lithium from polyuria due to acute lithium toxicity?

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