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Lithium toxicity. A case report

Published online by Cambridge University Press:  13 August 2021

E. Rodríguez Vázquez*
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. Capella Meseguer
Affiliation:
Psiquiatría, HCUV, Valladolid, Spain
I. Santos Carrasco
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
J. Gonçalves Cerejeira
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
A. Gonzaga Ramírez
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. Queipo De Llano De La Viuda
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
G. Guerra Valera
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. De Andrés Lobo
Affiliation:
Psiquiatría, HCUV, Valladolid, Spain
T. Jiménez Aparicio
Affiliation:
Psiquiatría, Hospital Clínico Universitario Valladolid, Valladolid, Spain
C. Vallecillo Adame
Affiliation:
Psiquiatría, Hospital Clínico Universitario Valldolid, Valladolid, Spain
*
*Corresponding author.

Abstract

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Introduction

Lithium is widely used in the treatment of the bipolar disorder. Once introduced, it is necessary to carry out an adequate control of the therapeutic range, since it is potentially toxic, and can affect various organs.

Objectives

To present the case of a patient suffering from lithium poisoning and to review the symptoms of lithium poisoning.

Methods

A descriptive study of a clinical case and review of the literature

Results

49-year-old woman, married. Diagnosed with bipolar disorder. She went to the emergency room due to a low level of consciousness, kidney failure, trembling of the limbs, hyperthermia and leukocytosis. In the last two weeks, the patient has reduced her intake of food, not water, finding herself more and more shaky and less reactive. Lithium in blood at admission 1.71, so conventional dialysis was performed with a progressive decrease into 0.65. On examination, he is practically mutist, bradypsychia with a significant response latency. Clinical judgment: Accidental lithium poisoning.

Conclusions

The primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Severe lithium neurotoxicity occurs almost exclusively in the context of chronic therapeutic administration of lithium and rarely results from acute ingestion of lithium, even in patients currently taking lithium. As such it is an iatrogenic illness, occurring in patients who have identifiable clinical risk factors: nephrogenic diabetes insipidus, older age, abnormal thyroid function and impaired renal function.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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