DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20184865

Accidental chronic lithium toxicity

Vangelis George Kanellis, Ramila Varendran

Abstract


Lithium is an effective first-line mood stabiliser for bipolar disorder, treatment-refractory depression and suicide prevention. Studies have demonstrated its ability to produce neuroprotective benefits. Despite this, Lithium can cause neurotoxicity, cardiotoxicity and endocrine derangement resulting in severe (and potentially permanent) side effects. Lithium toxicity can be precipitated by illness, salt restriction diets, dehydration, nephrogenic diabetes insipidus, impaired creatinine clearance, concomitant drugs. This is particularly true in older patients with altered pharmacodynamics and pharmacokinetics. We present a 52-year-old female who presented with prolonged signs of lithium toxicity post-diarrhoea. Lack of monitoring due to her nomadic life-style resulted in the combination of long-lasting neurotoxicity and thyroid dysfunction. Our patient displayed neurotoxicity that was not present on imaging. This highlights the importance of regular monitoring of renal function, lithium serum levels and neuro-endocrine function to reduce complications associated with lithium toxicity.


Keywords


Bipolar, Chronic, Endocrine, Lithium, Monitoring, Neurotoxicity, Renal, Thyroid, Toxicity

Full Text:

PDF

References


Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trialls. Am J Psychiatry. 2004;161:2:217-22.

Geddes JR, Goodwin G, Rendell J, Azorin JM, Cipriani A, Ostacher M, et al. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet. 2010;375:385-95.

Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005;162:10:1805-19.

Malhi GS, Tanious M, Das P, Coulston CM, Berk M. Potential Mechanisms of Action of Lithium in Bipolar Disorder. CNS Drugs. 2013;27:2:135.

Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. J Intensive Care Med. 2017;32:249-63.

McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379:721-8.

Shine B, McKnight RF, Leaver L, Geddes JR. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. The Lancet. 2015;386:9992:461-8.

Ott M, Bernd S, Ellinor SR, Ursula W. Lithium intoxication: incidence, clinical course and renal function- a population-based retrospective cohort study. J Psychopharmacol 2016;30:1008-19.

Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:2:239-45.

Menegueti MG, Basile-Filho A, Martins-Filho OA, Auxiliadora-Martins M. Severe arrhythmia after lithium intoxication in a patient with bipolar disorder admitted to the intensive care unit. Indian J Crit Care Med. 2012;16:109-11.

Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord 2016;4:27.

Livingstone C, Rampes H. Lithium: a review of its metabolic adverse effects. J Psychopharmacol 2006;20:3:347-55.

Vermeire S, Vanbrabant P, Van Boxstael P, Sabbe M. Severity (and treatment) ofchronic lithium poisoning: clinical signs or lab results as a criterion? Acta Clinica Belgica. 2010;65:2:27-8.

Zaworski J, Delannoy PY, Boussekey N, Thellier D, Georges H, Leroy O. Lithium. one drug, five complications. J Intensive Care 2017;5:1:70.