Past Issues

Lithium Intoxication with Impaired Renal Function

Ana Isabel Wu, M.D.1 Shen-Chieh Chang, M.D.1 Tso-Hsiao Chen, M.D.2  Winston W. Shen, M.D.1,3 

Objectives:Lithium is a time-honored medication for treating bipolar disorder. The Food and Drug Administration of the United States approved the indication of lithium for treating acute mania in 1970 and for prophylaxis of bipolar disorder in 1974. But lithium is notorious for its narrow therapeutic window and numerous side effects which need to be highlighted for practicing psychiatrists occasionally. Thus, we present this clinical conference of a patient with various lithium- related side effects to familialize psychiatrist readers. The Case:This 44-yearold Taiwanese female patient with a history of bipolar I disorder and 16-year lithium treatment, was admitted to the medical ward of a general hospital after two visits at emergency department. Her clinical pictures showed diffi culty in breathing, fl uctuating consciousness, hand tremors, and dysphoric mood. Her abnormal laboratory fi ndings showed serum lithium levels 3.31 mEq/L and 2.76 mEq/L on two occasions, BUN 60 mg/dL, creatinine 4.4 mg/dL, urine specifi c gravity 1.006, and estimated glomerular fi ltration rate19.6 mL/min. Conclusion:In this case conference, we have discussed the clinical picture of acute and chronic lithium intoxication as well as addressed the issues of treatment modalities and pathophysiology of lithium-related renal toxicity.
Key Word Lithium intoxication, renal function, nephropathy
Editorial Committe, Taiwanese Journal of Psychiatry
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