Reactions 1680, p206 - 2 Dec 2017 Lithium toxicity: case report A 38-year-old male developed lithium toxicity during treatment with lithium [route and time to reaction onset not stated]. The man with a history of type 1 bipolar disorder with psychotic features was maintained on lithium therapy. He presented to emergency department with red-tinged faced with periorbital sparing and disorganized thinking/confusion. Due to his mental status, he was unable to provide medical history, but his lithium level was found to be 1.8 mg/dL. His history stated multiple psychiatric hospitalisations. He was maintained on lithium 900mg 3 times a day and most recent (one month ago) blood level of 0.9 mg/dL was noted. He travelled by air through multiple states and was found collapsed at airport wash room, after which he was taken to the emergency department. During initial presentation, he was found tremulous, confused, disorganized and agitated with tachycardia and signs of autonomic instability. Laboratory examination revealed TSH 5.7 and lithium level 1.8 [units not stated]. EKG exhibited sinus rhythm with QTc prolongation 499 msec and T wave inversions, which was suggestive of lithium toxicity. The man’s lithium treatment was discontinued, and he was treated with IV fluids, folic acid and thiamine. Gradually, lithium level was found to be decreased to a therapeutic range, and his condition improved after correction of electrolyte imbalances and rehydration. Author comment: "This case illustrates that lithium toxicity can result from dehydration due to a combination of both warm climate exposure and air travel." Manocha P, et al. A patient taking lithium: The impact of air travel and dehydration. CNS Spectrums 21: 109-110, No. 1, Feb 2016. Available from: URL: http://doi.org/10.1017/S1092852915000905 [abstract] - USA 803284790 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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