Abstract
BackgroundLithium poisoning could trigger multiple complications. We report the case of a lithium poisoning with five complications that are described for the first time together.Case reportA 60-year-old woman was admitted in our intensive care unit for altered consciousness. Severe lithium intoxication was diagnosed (lithium plasmatic level 8.21 mmol/l) associated with acute oliguric kidney failure. Continuous renal replacement therapy was started immediately. Orotracheal intubation was quickly required because of status epilepticus. Medullary aplasia happened 48 h after the patient was intubated. Infectious and immunological causes were ruled out and lithium poisoning was considered as the most likely etiology. Iterative blood and platelet transfusion were required. Severe polyneuropathy was diagnosed on the 5th day after admission. The patient showed a peripheral tetraparesia and cranial nerve failure while lithium plasmatic level had decreased to a therapeutic level. Conversely, urine output increased and hypernatremia promptly occurred, which led to diabetes insipidus diagnosis. Neuropathy decreased in 72 h and the patient was definitely extubated by the 11th day. Hematologic disturbances decreased and no blood transfusion would be required after the 8th day. The patient would keep sequellas of the poisoning. Thin motricity would still be altered and polyuria would remain. Diffuse alopecia was promptly observed, with no iron deficiency or thyroid disturbance.ConclusionIn addition to presenting this case report, we herein discuss the drug causality, the consequences, and the plausible pathophysiology of these five situations.
Highlights
Most of the lithium poisonings are associated with infections or drug association [3], the most frequent being with diuretics or angiotensin-converting enzyme inhibitors
Self-administration of toxic doses may account for 20% of the hospitalized poisoning [4].The case we report shows multiple lithium complications: pancytopenia, polyneuropathy, diabetes insipidus nephrogenic, seizure, and alopecia
Acute on chronic lithium poisoning is associated with a poorer prognosis as compared to non-previously exposed patients, mainly because of a more frequent central nervous system failure (CNS) [5]
Summary
Lithium is the first-line treatment for bipolar disorder. Lithium poisoning was historically associated with a 25% mortality [1]. Self-administration of toxic doses may account for 20% of the hospitalized poisoning [4].The case we report shows multiple lithium complications: pancytopenia, polyneuropathy, diabetes insipidus nephrogenic, seizure, and alopecia. A 60-year-old woman was admitted to our intensive care unit (ICU) for altered consciousness She was receiving lithium for a bipolar disorder for more than 10 years. Her last lithium level was on the therapeutic window (1.19 mmol/l 2 months before the admission) with a 400-mg twice-daily lithium carbonate intake without recent change in her drug regime. The lithium level was belatedly obtained soon after the patient was intubated. It was at 8.21 mmol/l (therapeutic window 0.7–1.2 mmol/l). We report the case of a severe acute on chronic lithium intoxication with five scarcely reported complications
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