Lithium
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Lithium intoxication: case report A 44-year-old woman developed lithium intoxication during treatment with lithium for bipolar disorder [duration of treatment to reaction onset not stated]. The woman, who had a history of dyslipidaemia, bipolar disorder, type II diabetes mellitus, hypertension and morbid obesity, had undergone bariatric surgery before 1 month. She presented to the emergency department with 1 week of progressive deterioration marked by fatigue, muscle weakness, mental confusion, tremors of the upper limbs, difficulties in motor coordination, nausea and diarrhoea. She had been receiving quetiapine, fluoxetine and lorazepam and chronic therapy with lithium [lithium carbonate] 600mg [route not stated] for 8 years for bipolar disorder. In the neurological examination (at the current presentation), ataxia and hyperreflexia were noted. She was observed to be disoriented in time and space, and obnubilated. She displayed attention; however, she got easily distracted in a few moments. She did not co-operate in the remaining mental examination. She was assessed to have acute renal failure based on laboratory parameters including hyponatraemia 128 mEq/L, creatinine 3.0 mg/dL and urea 130 mg/dL. After estimation of increased lithaemia, lithium intoxication was suspected. The woman was admitted to the internal medicine service. She was initiated on hydration, and lithium was discontinued. She showed rapid and progressive analytical improvement in 5 days. Due to difficulty in total lithium clearance, lithium was not reintroduced, with the maintenance of euthymic mood. MARQUES AR, et al. Lithium intoxication after bariatric surgery: A case report. [Portuguese]. Acta Medica Portuguesa 33: no pagination, No. 13, Jan 2020. Available from: 803520037 URL: http://doi.org/10.20344/AMP.12868 [Portuguese; summarised from a translation]
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Reactions 12 Dec 2020 No. 1834
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