Lithium Toxicity at Therapeutic Blood Levels: A Case Report

Article Sidebar

PDF
Published: Nov 2, 2015
DOI: https://doi.org/10.18192/uojm.v5i2.1368
Keywords:
Lithium toxicity

Main Article Content

Alexandra Elizabeth Quimby
University of Ottawa, Department of Undergraduate Medicine
Rajeev Sachdeva
Royal Ottawa Mental Health Centre

Abstract

ABSTRACT:

This report describes a case of lithium toxicity occurring at therapeutic blood levels in a 47-year-old man with bipolar disorder and a history of alcohol abuse. We discuss the clinical presentation of lithium toxicity, as well as factors that may contribute to a reduction in the blood levels required for the precipitation of toxic effects. In addition, we review the literature on cases of lithium toxicity occurring at therapeutic blood levels, including diagnosis and management thereof.


RÉSUMÉ:

Ce rapport décrit un cas de toxicité au lithium se produisant à des niveaux sanguins thérapeutiques chez un homme de 47 ans avec un trouble bipolaire et une histoire d’abus d’alcool. Nous discutons la présentation clinique de toxicité au lithium, ainsi que les facteurs pouvant contribuer à une réduction des niveaux sanguins nécessaires à la précipitation des effets toxiques. En outre, nous passons en revue la littérature sur les cas de toxicité au lithium se produisant à des niveaux sanguins thérapeutiques, y compris son diagnostic et sa gestion.

Article Details

Issue
Vol. 5 No. 2 (2015): Neuroscience and Mental Health
Section
Case Report & Elective report
  1. Authors publishing in the UOJM retain copyright of their articles, including all the drafts and the final published version in the journal.
  2. While UOJM does not retain any rights to the articles submitted, by agreeing to publish in UOJM, authors are granting the journal right of first publication and distribution rights of their articles.
  3. Authors are free to submit their works to other publications, including journals, institutional repositories or books, with an acknowledgment of its initial publication in UOJM.
  4. Copies of UOJM are distributed both in print and online, and all materials will be publicly available online. The journal holds no legal responsibility as to how these materials will be used by the public.
  5. Please ensure that all authors, co-authors and investigators have read and agree to these terms.
  6. Works are  licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Author Biographies

Alexandra Elizabeth Quimby, University of Ottawa, Department of Undergraduate Medicine

BSc

Rajeev Sachdeva, Royal Ottawa Mental Health Centre

MD; University of Ottawa, Department of Psychiatry.

References

1. American Psychiatric Association. Diagnostic and Statistical manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.

2. American Psychiatric Association. Practice guidelines for the treatment of patients with bipolar disorder. American Journal of Psychiatry 2002;159(4 Suppl):1-50.

3. Singer I, Rotenberg D. Mechanisms of lithium action. N Engl J Med 1972;289:254. http://dx.doi.org/10.1056/NEJM197308022890508

4. Malhi GS, Tanious M, Das P, Coulston CM, Berk M. Potential mechanisms of action of lithium in bipolar disorder. CNS Drugs 2013;27:135-153.

5. Timmer RT, Sands JM. Lithium intoxication. J Am Soc Nephrol 1999;10:666.

6.Amisden A. Clinical features and management of lithium poisoning. Med Toxicol Adverse Drug Exp 1988;3:18.

7. Hansen HE, Amidisen A. Lithium intoxication. (Report of 23 cases and review of 100 cases from the literature). Q J Med 1978;47:123.

8. Okusa MD, Crystal LJ. Clinical manifestations and management of acute lithium intoxication. Am J Med 1994;97:383.

9. Hauger RL, O’Connor KA, Yudofsky S, Meltzer HL. Lithium toxicity: when is hemodialysis necessary? Acta Psychiatr Scand 1990;81:515.

9. Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neuroxicity. Clin Neuropharmacol 2005;28(1):38.

10. Perrone J, Chatterjee P. Lithium Poisoning. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on May 8, 2015.)

11. Ng F, Hallam K, Lucas N, Berk M. The role of lamotrigine in the management of bipolar disorder. Neuropsychiatr Dis Treat 2007;3(4):463-474.

12. Lexi-Comp, Inc. (Lexi-Drugs® ). Lexi-Comp, Inc.; August 11, 2015.

13. Bell, A J ; Cole, A ; Eccleston, D ; Ferrier, I N. Lithium neurotoxicity at normal therapeutic levels. Br J of Psychiatry 1993;162:689-692.

14. Speirs J, HIrsch SR. Severe lithium toxicity with “normal” serum concentrations. Br Med J. 1978;1(6116):815.

15. Venkatarathnamma PN, Patil AR, Nanjundaiah N. Fatal lithium toxicity with therapeutic levels- a case report. Int J Clin Pharmacol Ther. 2011 May;49(5):336-8.

16. Miao YK. Lithium neurotoxicity within the therapeutic serum range.(Case Report). Hong Kong Journal of Psychiatry, March, 2002, Vol.12(1), p.19(4)

17. Gangadhar BN, Subhash MN, Umapathy C, Janakiramaiah N. Lithium toxicity at therapeutic serum levels. The British Journal of psychiatry 1993;163:695.