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Lithium toxicity with renal insufficiency and neurological symptoms: case report A 63-year-old man with diabetes mellitus developed lithium toxicity with renal insufficiency and neurological symptoms during concomitant administration of lithium, maprotiline and haloperidol [indications and durations of treatment to reaction onset not stated]. The man presented with sleepiness, exhaustion, psychomotor slowness and oliguria. When hospitalised, he had slowed movements. Laboratory tests revealed the following: urea 23.2 mmol/L, creatinine 561 µmol/L, sodium 157 mmol/L, pO2 7.6 kPa, oxygen saturation 88%, pH 7.25, base excess -13 mmol/L and lactate 4.8 mmol/L. He received symptomatic therapy and intensive electrolyte status correction with sodium chloride and furosemide. Over the following 3 days, laboratory analyses revealed the development of acute renal insufficiency. He appeared confused and deeply somnolent; he subsequently had neurological extrapyramidal symptomatology. It was revealed that 2 days prior to hospitalisation, he had lost consciousness while burning hay, and his difficulties had subsequently developed. He was regularly taking maprotiline tablets at 125 mg/day and haloperidol tablets at 4 mg/day, and had been receiving lithium tablets at 900 mg/day for several years. All his medication was stopped after hospitalisation. Lithium toxicity was suspected; his lithium concentration was 1.46 mmol/L. The man received ten haemodialysis sessions over the following 10 days. His state of mind improved, and his serum levels of nitrogen substances fell. His lithium level was 1.17 mmol/L after the fifth session, and was within the range of reference values after the tenth session. His renal function recovered, and he was discharged after 17 days. Seven days after discharge, he was in a good general state. Author comment: "Patient was on lithium therapy for several years; had no significantly increased level of lithium in serum, but was manifesting symptoms of toxicity (Naranjo Scale score 5 (5-8 = probable ADR). Severity in this case was provoked by hemoconcentration due to dehydration. . . . Diabetes mellitus is surely [a] significant factor that contributed to acute renal insufficiency, as well as [the] combination of lithium and tetracyclic antidepressant and antipsychotic." Ristic DI, et al. Unrecognized acute lithium toxicity: A case report. Central European Journal of Medicine 7: 700-703, No. 6, Dec 2012. Available from: URL: 803083373 http://dx.doi.org/10.2478/s11536-012-0058-0 - Serbia

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Reactions 23 Feb 2013 No. 1440