Insights into Chronic Lithium Toxicity - A Case Report.

BACKGROUND: Bipolar disorder is a chronic psychological disorder, and lithium remains the mainstay of therapy. Lithium toxicity can be acute or chronic and the effects may be disabling or life-threatening. The presence of risk factors can increase the chances of lithium toxicity in a patient on long-term lithium therapy. We hereby report a case of chronic lithium toxicity in a patient with a known case of bipolar disorder. CASE PRESENTATION: A 44-year-old female patient with a known case of bipolar disorder presented with altered sensorium, seizures, and renal insufficiency. On admission, the patient was severely dehydrated and the serum lithium level was 3.43 mEq/L. Hemodialysis was performed and she improved gradually. CONCLUSION: Lithium has constantly proven to be beneficial in lowering suicide rates in bipolar disorder patients over the years since its approval. However, its use is limited due to the risk of toxicity. The chances of developing toxicity are higher in patients on long-term lithium therapy. Patients with high risk factors for toxicity should be monitored frequently as the effects of lithium toxicity can be fatal.

Outbreak of Nosocomial Infection from an Unusual Source.

Hospital-acquired infections have been a wide-ranging concern in the medical field, as it increases mortality and incurs longer hospital stays and higher medical costs. Infection control practices and antimicrobial stewardship are thought to be emergent measures to curtail hospital-acquired infections, but adherence to such standard practices has been a concern globally, ultimately leading to poor clinical outcomes. Organisms isolated from rare sources have been reported to cause pathogenic infections in humans. Instances such as contamination of intravenous fluids and parenteral medications with gram-negative bacteria and fungus have been reported in the past. We present here, a rare outbreak of Ralstonia pickettii bacteremia from an unthought source among four critically ill patients. The epidemiological investigations confirmed the source of contagion to be fentanyl ampoules. The immediate action of disusing the batch of fentanyl ampoules was taken. Timely action and isolation precautions prevented a major outbreak within the intensive care unit (ICU). How to cite this article: Rajachandran K, Varghese GS, Kumar JV, Mathew KT. Outbreak of Nosocomial Infection from an Unusual Source. Indian J Crit Care Med 2022;26(9):1042-1044.