A case of lithium poisoning with a maintenance dose treated by hemodialysis / 대한내과학회지

ABSTRACT

Lithium is a commonly prescribed drug for bipolar disorder. Because of the narrow therapeutic range, lithium intoxication continues to be prevalent. Drugs that alter renal function such as ACEI, ARB, NSAIDS, and thiazide can increase the risk of chronic lithium toxicity even to stable patients. A 65-year old woman was admitted for hand tremor, cognitive impairment, and lethargy. A medical history included major depressive disorder, mitral stenosis, atrial fibrillation, and hypertension. Her prescription included lithium, quetiapine, digoxin, furosemide, and warfarin. She recently received Atacand Plus (candesartan plus thiazide) for hypertension. At the time of admission, the patient was drowsy and confused. The serum lithium level was 4.25 mEq/L. The patient received hydration. Due to neurologic complications and the degree of lithium toxicity, a total of three sessions of hemodialysis were performed, and the post-dialysis serum lithium level was 0.54 mEq/L. The neurologic symptoms recovered completely after a third dialysis session.