J Korean Soc Clin Toxicol.  2013 Jun;11(1):28-30.

Delayed Continuous Venovenous Hemodiafiltration in Chronic Lithium Intoxication

• Kim TS
• Cha YS
• Kim H
• Kim OH
• Cha KC
• Lee KH
• Hwang SO

Abstract

A 66-year-old male with chronic alcoholism presented with tremor, gait disturbance, memory impairment, insomnia, decreased appetite, and confusion. The patient had been taking lithium daily for treatment of bipolar disorder. Brain CT showed no specific abnormality, and serum lithium and ammonia levels were 3.63 mEq/L (therapeutic range, 0.6~1.2 mEq/L) and 85microg/dL (reference range: 19~54microg/dL), respectively. Therefore, the initial differential diagnosis included chronic lithium intoxication, hepatic encephalopathy, Wernicke encephalopathy, or alcohol withdrawal syndrome. Even with the provision of adequate hydration, the patient's neurologic status did not show improvement, so that lactulose enema, thiamine replacement, and continuous venovenous hemodiafiltration (CVVHDF) were started on the third admission day. By the fifth admission day he had made a rapid neurologic recovery, and was discharged on the 20th admission day. Therefore, CVVHDF might be a treatment for patients with chronic lithium intoxication, because, even if serum lithium concentration is normal, lithium concentration in the brain may be different from that of the serum.

Keyword

Chronic lithium intoxication; Continuous venovenous hemodiafiltration

MeSH Terms

Aged
Alcoholism
Ammonia
Appetite
Bipolar Disorder
Brain
Diagnosis, Differential
Enema
Gait
Hemodiafiltration
Hepatic Encephalopathy
Humans
Lactulose
Lithium
Male
Memory
Sleep Initiation and Maintenance Disorders
Thiamine
Tremor
Wernicke Encephalopathy
Ammonia
Lactulose
Lithium
Thiamine