Korean J Med.  2007 Jan;72(1):95-99.

A case of lithium poisoning with a maintenance dose treated by hemodialysis

• Yoon SI
• Kim BC
• Kwon SK
• Kim HY
• Kim SK

Abstract

Lithium is a commonly prescribed drug for bipolar disorder. Because of the narrow therapeutic range, lithium intoxication continues to be prevalent. Drugs that alter renal function such as ACEI, ARB, NSAIDS, and thiazide can increase the risk of chronic lithium toxicity even to stable patients. A 65-year old woman was admitted for hand tremor, cognitive impairment, and lethargy. A medical history included major depressive disorder, mitral stenosis, atrial fibrillation, and hypertension. Her prescription included lithium, quetiapine, digoxin, furosemide, and warfarin. She recently received Atacand Plus (candesartan plus thiazide) for hypertension. At the time of admission, the patient was drowsy and confused. The serum lithium level was 4.25 mEq/L. The patient received hydration. Due to neurologic complications and the degree of lithium toxicity, a total of three sessions of hemodialysis were performed, and the post-dialysis serum lithium level was 0.54 mEq/L. The neurologic symptoms recovered completely after a third dialysis session.

Keyword

Lithium poisoning; Angiotensin-converting enzyme inhibitor; Hemodialysis

MeSH Terms

Aged
Anti-Inflammatory Agents, Non-Steroidal
Atrial Fibrillation
Bipolar Disorder
Depressive Disorder, Major
Dialysis
Digoxin
Female
Furosemide
Hand
Humans
Hypertension
Lethargy
Lithium*
Mitral Valve Stenosis
Neurologic Manifestations
Poisoning*
Prescriptions
Renal Dialysis*
Tremor
Warfarin
Quetiapine Fumarate
Anti-Inflammatory Agents, Non-Steroidal
Digoxin
Furosemide
Lithium
Warfarin