Lithium Intoxication with Impaired Renal Function

Abstract

Background: 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 difficulty in breathing, fluctuating consciousness, hand tremors, and dysphoric mood. Her abnormal laboratory findings 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 specific gravity 1.006, and estimated glomerular filtration 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.