Lithium
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GI disorders and encephalopathy secondary to lithium toxicity: case report A 36-year-old woman developed nausea, vomiting and encephalopathy secondary to lithium toxicity during treatment with lithium for major depressive disorder. The woman, who had a history of major depressive disorder, post-traumatic stress disorder, borderline personality disorder, migraine headaches, back pain, and morbid obesity, underwent laparoscopic sleeve gastrectomy. However, following laparoscopic sleeve gastrectomy, she developed nausea and vomiting. Additionally, she experienced difficulty in swallowing medications, which included lithium [lithium carbonate] capsules (300mg taken in the morning and 600mg taken in the evening), promethazine and various other medications. The lithium level was 0.62 mmol/L before the sleeve gastrectomy. About 4 months after the surgery, the lithium level increased to 1.47 mmol/L. Approximately 6 months after the surgery, she presented to the emergency department following a fall. She reported of nausea, light-headedness and a ’feeling of her legs giving out’. Urinalysis was positive for leucocyte esterase, nitrite, squamous epithelial cells and bacteria. A basic metabolic panel revealed potassium 3.6 mmol/L, sodium 138 mmol/L, chloride 102 mmol/L, creatinine 0.92 mg/dL, urea nitrogen 8 mg/dL, calcium 10.1 mg/dL and glucose 135 mg/dL. A complete blood count showed haemoglobin 12.6 g/dL, haematocrit 38.4%, WBC 6700 /µL and platelet 299000 /µL. The lithium level was noted to be increased to 1.63 mmol/L. The differential diagnoses included GI infection, dehydration and lithium toxicity. She was advised to hold lithium for 2 days. After evaluation of her records, the dose of lithium was reduced to 300mg twice daily. However, she returned to the emergency department 10 days after the first presentation due to difficulty walking and one fall, as well as somnolence. At that time, lithium level was noted as 1.10 mmol/L. She was hospitalised for encephalopathy. In addition to lithium toxicity, differential diagnoses of acute kidney injury, dehydration and infection were considered. The dose of lithium was reduced to 150mg twice daily. Consequently, she did not experience further episodes of supratherapeutic levels of lithium, falls and somnolence. Nine months later, her lithium level was noted to be 1.02 mmol/L, while being on lithium 150mg twice daily. One year after the surgery, the lithium level was obtained as 0.53 mmol/L. Jamison SC, et al. Lithium toxicity following bariatric surgery. SAGE Open Medical Case Reports 8: no pagination, Jan 2020
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Reactions 10 Oct 2020 No. 1825
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