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In this case report, a female in her 60s presented to a tertiary care hospital with lithium toxicity. 24 hour monitoring was done, nephrology team opinion was obtained and patient was put on renal replacement therapy. Patient was started on lithium again, once the lithium levels fell within the normal therapeutic range ( between 4.7mEq/L and 0.67 mEq/L ). In this particular instance, patient devoloped slurring of speech followed by catatonia a little later. This case report is meant to discuss the factors that predispose the respective group of patients to neurotoxicity.
Cade JF. Lithium salts in the treatment of psychotic excitement. Med J Aust 1949;2:349–52.
NICE. Bipolar disorder: assessment and management. London: NICE, 2016.
Taylor D, Paton C, Kapur S. The Maudsley Prescribing Guidelines in Psychiatry. Twelfth edn, John Wiley and Sons, 2015.
Yung CY. A review of clinical trials of lithium in neurology. Pharmacol Biochem Behav 1984;21(Suppl 1):57–64. 10.1016/0091-3057(84)90164-3.
Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry 2001;35:833–40. 10.1046/j.1440-1614.2001.00963.
Bartha L, Marksteiner J, Bauer G, et al.. Persistent cognitive deficits associated with lithium intoxication: a neuropsychological case description. Cortex 2002;38:743–52. 10.1016/S0010-9452(08)70041-8.
Grueneberger EC, Maria Rountree E, Baron Short E, et al.. Neurotoxicity with therapeutic lithium levels: a case report. J Psychiatr Pract 2009;15:60–3. 10.1097/01.pra.0000344921.36157.
Mangano WE, Montine TJ, Hulette CM. Pathologic assessment of cerebellar atrophy following acute lithium intoxication. Clin Neuropathol 1997;16:30–3.
Kores B, Lader MH. Irreversible lithium neurotoxicity: an overview. Clin Neuropharmacol 1997;20:283–99.
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;10:875–87. 10.2215/CJN.10021014.
Alexopoulos GS, Bruce ML, Hull J, et al.. Clinical determinants of suicidal ideation and behavior in geriatric depression. Arch Gen Psychiatry 1999;56:1048–53. 10.1001/ archpsyc.56.11.1048.
Fernando I. Predicting serum drug level using the principles of pharmacokinetics after an overdose: a case of lithium overdose. Australas Psychiatry 2017;25:391–4. 13.1177/1039856216689624