Generic placeholder image

Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Case Report

Insights into Chronic Lithium Toxicity - A Case Report

Author(s): Giphy Susan Varghese*, Karthikkeyan Rajachandran and Indhupriyadharshini Murugesan

Volume 18, Issue 1, 2023

Published on: 23 May, 2022

Page: [112 - 115] Pages: 4

DOI: 10.2174/1574886317666220414133850

Price: $65

conference banner
Abstract

Background: Bipolar disorder is a chronic psychological disorder, and lithium remains the mainstay of therapy. Lithium toxicity can be acute or chronic and the effects may be disabling or life-threatening. The presence of risk factors can increase the chances of lithium toxicity in a patient on long-term lithium therapy. We hereby report a case of chronic lithium toxicity in a patient with a known case of bipolar disorder.

Case Presentation: A 44-year-old female patient with a known case of bipolar disorder presented with altered sensorium, seizures, and renal insufficiency. On admission, the patient was severely dehydrated and the serum lithium level was 3.43 mEq/L. Hemodialysis was performed and she improved gradually.

Conclusion: Lithium has constantly proven to be beneficial in lowering suicide rates in bipolar disorder patients over the years since its approval. However, its use is limited due to the risk of toxicity. The chances of developing toxicity are higher in patients on long-term lithium therapy. Patients with high risk factors for toxicity should be monitored frequently as the effects of lithium toxicity can be fatal.

Keywords: Bipolar disorder, lithium carbonate, chronic lithium toxicity, serum lithium levels, seizures, renal insufficiency, hemodialysis.

Graphical Abstract

[1]
Curran G, Ravindran A. Lithium for bipolar disorder: A review of the recent literature. Expert Rev Neurother 2014; 14(9): 1079-98.
[http://dx.doi.org/10.1586/14737175.2014.947965] [PMID: 25130062]
[2]
Wen J, Sawmiller D, Wheeldon B, Tan J. A review for lithium: Pharmacokinetics, drug design, and toxicity. CNS Neurol Disord Drug Targets 2019; 18(10): 769-78.
[http://dx.doi.org/10.2174/1871527318666191114095249] [PMID: 31724518]
[3]
Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. J Intensive Care Med 2017; 32(4): 249-63.
[http://dx.doi.org/10.1177/0885066616651582] [PMID: 27516079]
[4]
FDA. Lithium carbonate tablets USP, lithium carbonate capsules USP, lithium oral solution USP, Columbus, Ohio. Roxane Laboratories, Inc. 2011. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf
[5]
Timmer RT, Sands JM. Lithium intoxication. J Am Soc Nephrol 1999; 10(3): 666-74.
[http://dx.doi.org/10.1681/ASN.V103666] [PMID: 10073618]
[6]
Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol 2018; 8(9): 251-69.
[http://dx.doi.org/10.1177/2045125318769235] [PMID: 30181867]
[7]
National institute of mental health. Bipolar disorder. Available from: https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml
[8]
Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet 2013; 381(9878): 1672-82.
[http://dx.doi.org/10.1016/S0140-6736(13)60857-0] [PMID: 23663953]
[9]
Shorter E. The history of lithium therapy. Bipolar Disord 2009; 11 (Suppl. 2): 4-9.
[http://dx.doi.org/10.1111/j.1399-5618.2009.00706.x]
[10]
Lewitzka U, Severus E, Bauer R, Ritter P, Müller-Oerlinghausen B, Bauer M. The suicide prevention effect of lithium: More than 20 years of evidence-a narrative review. Int J Bipolar Disord 2015; 3(1): 32.
[http://dx.doi.org/10.1186/s40345-015-0032-2] [PMID: 26183461]
[11]
UpToDate. Lithium poisoning. Available from: https://www.uptodate.com/contents/lithium-poisoning
[12]
McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: A systematic review and meta-analysis. Lancet 2012; 379(9817): 721-8.
[http://dx.doi.org/10.1016/S0140-6736(11)61516-X] [PMID: 22265699]
[13]
Mehta N, Vannozzi R. Lithium-induced electrocardiographic changes: A complete review. Clin Cardiol 2017; 40(12): 1363-7.
[http://dx.doi.org/10.1002/clc.22822] [PMID: 29247520]
[14]
de Cates AN, Morlet J, Antoun Reyad A, Tadros G. Lithium overdose and delayed severe neurotoxicity: Timing for renal replacement therapy and restarting of lithium. BMJ Case Rep 2017; 2017: bcr-2017-222453.
[http://dx.doi.org/10.1136/bcr-2017-222453] [PMID: 29070624]
[15]
Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28(1): 38-49.
[http://dx.doi.org/10.1097/01.wnf.0000150871.52253.b7] [PMID: 15714160]
[16]
Oakley PW, Whyte IM, Carter GL. Lithium toxicity: An iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry 2001; 35(6): 833-40.
[http://dx.doi.org/10.1046/j.1440-1614.2001.00963.x] [PMID: 11990895]
[17]
Mangano WE, Montine TJ, Hulette CM. Pathologic assessment of cerebellar atrophy following acute lithium intoxication. Clin Neuropathol 1997; 16(1): 30-3.
[PMID: 9020392]
[18]
Evrensel A, Ünsalver BÖ, Ceylan ME, Cömert G. Lithium-induced cortical atrophy and cognitive dysfunction. BMJ Case Rep 2014; 2014: bcr2014207646.
[http://dx.doi.org/10.1136/bcr-2014-207646]
[19]
Young W. Review of lithium effects on brain and blood. Cell Transplant 2009; 18(9): 951-75.
[http://dx.doi.org/10.3727/096368909X471251] [PMID: 19523343]
[20]
Demers RG, Heninger GR. Electrocardiographic T-wave changes during lithium carbonate treatment. JAMA 1971; 218(3): 381-6.
[http://dx.doi.org/10.1001/jama.1971.03190160031006] [PMID: 5109863]
[21]
Decker BS, Goldfarb DS, Dargan PI, et al. Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin J Am Soc Nephrol 2015; 10(5): 875-87.
[http://dx.doi.org/10.2215/CJN.10021014] [PMID: 25583292]
[22]
Achong MR, Fernandez PG, McLeod PJ. Fatal self-poisoning with lithium carbonate. Can Med Assoc J 1975; 112(7): 868-70.
[PMID: 1122460]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy