scholarly journals A case of unsuspected chronic lithium toxicity presenting with neurological symptoms

2021 ◽  
Vol 9 (1) ◽  
pp. 46-48
Author(s):  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Therapeutic Index ◽  
Lithium Carbonate ◽  
Neurological Symptoms ◽  
Lower Limbs ◽  
Lithium Level ◽  
Oral Antidiabetic Agent ◽  
Chronic Alcoholic ◽  
Altered Level ◽  
Serum Lithium Level ◽  
Beneficial Effects

Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has beneficial effects on prophylactic use in Acute manic episodes to prevent recurrence and reduces rate of suicide associated with affective disorder. Low therapeutic index of Lithium (0.8-1.2meq/l) mandates regular and frequent measurement of Serum lithium level in patients taking this drug. Here we present a 59 years Indian male who is a known diabetic, chronic alcoholic and a case of bipolar disorder. He was on Lithium tablet off and on for last 4 years and was also on oral antidiabetic agent. He was admitted in ICU through emergency with complaints of altered level of consciousness for 2 days with H/O recurrent hypoglycemia associated with nausea, reduced food intake, vertigo, tremor of all four limbs with weakness of both lower limbs for approximately last 2 months. Admission serum lithium level was 2.24meq/l. Hemodialysis was started. Neurological symptoms improved and serum Lithium level returned to normal (0.79meq/l) after 2 session of hemodialysis. Bangladesh Crit Care J March 2021; 9(1): 46-48

What is the optimal serum lithium level in the long-term treatment of bipolar disorder? A review

2007 ◽  
Vol 40 (06) ◽  
Author(s):  
E Severus ◽  
N Kleindienst ◽  
F Seemüller ◽  
S Frangou ◽  
HJ Möller ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Term Treatment ◽  
Lithium Level ◽  
Serum Lithium Level ◽  
Long Term Treatment

scholarly journals Atypical Manifestation of Polyneuropathy in Covid-19

2021 ◽  
Author(s):  
Nayara de Lima Froio ◽  
Ana Luisa Rosas Sarmento ◽  
Sonia Maria Cesar de Azevedo Silva ◽  
Lilia Azzi Collet da Rocha Camargo
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Sore Throat ◽  
Neurological Symptoms ◽  
Lower Limbs ◽  
Neurological Manifestations ◽  
Sensory Motor ◽  
Hands And Feet ◽  
Atypical Manifestation

Context: Neurological manifestations of Sars-CoV-2 are progressively emerging. Cases of Guillain-Barré syndrome and its variants, with onset about 5-10 days after influenza symptoms, have been described. This paper reports a case of polyneuropathy with onset 90 days after a sore throat episode and persistence of IgM positivity in serology for Sars- Cov-2. We aim to raise awareness of this possibility. Case Report: A 56-year-old male, hypertensive, presented with sore throat on April 21, 2020. Serology for Covid-19 was performed with positive IgM. There was complete improvement of the symptom. At the end of July, he started a symmetrical paresthesia in the feet with ascension to the knees and, on August 20, paresthesia in the hands too. So, he went to IAMSPE (SP) and tactile and painful hypoesthesia in hands and feet, hypopalesthesia in lower limbs, a fall in the lower limbs upon Mingazzini’s maneuver, global hyporeflexia and talon gait were found. Just the following tests were changed: second Covid-19 serology IgM and IgG positives; ENMG: sensory motor polyneuropathy, primarily axonal, with signs of chronicity and without signs of acute denervation in the current. Started gabapentin and physical therapy. Patient still has paresthesia in hands and feet, but with partial improvement. Conclusion: This case alerts to neurological symptoms of Covid-19 in the medium and long term.

Supervising Lithium a Comparison of a Lithium Clinic, Psychiatric Out-patient Clinics, and General Practice

1988 ◽  
Vol 152 (4) ◽  
pp. 535-538 ◽  
Author(s):  
George Masterton ◽  
Mary Warner ◽  
Brian Roxburgh
Keyword(s):  
General Practice ◽  
Glomerular Filtration ◽  
Lithium Treatment ◽  
Lithium Level ◽  
Once Daily ◽  
Serum Lithium Level ◽  
Daily Dose

Supervision of lithium treatment among three groups of patients treated in different settings – at a lithium clinic, as hospital out-patients, and by a GP – was studied. The lithium clinic maintained lower levels and checked these more frequently. Elevated lithium levels were most frequent in the GP-supervised group, which also included the 13 patients with the most impaired glomerular filtration. In hospital settings GFR-impaired patients received a lower daily dose of lithium; in general practice, affected patients had a higher mean serum lithium level and were more frequently prescribed lithium once daily. We conclude that patients with glomerular impairment who require lithium should be supervised by a specialist, or at least prescribed lithium in divided daily doses.

The Utility of a Single-Point Dosing Protocol for Predicting Steady-State Lithium Levels

1986 ◽  
Vol 148 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Paul J. Perry ◽  
Bruce Alexander ◽  
Randall A. Prince ◽  
Frederick J. Dunner
Keyword(s):  
Steady State ◽  
Affective Disorder ◽  
Single Point ◽  
Test Dose ◽  
Point Method ◽  
Lithium Level ◽  
Clinical Interpretation ◽  
Serum Lithium Level ◽  
Steady State Serum

Two methods for predicting steady-state serum lithium level were compared prospectively in in-patients suffering from affective disorder. A single-point prospective administration model that required a single 24-hour serum lithium level, following a test dose produced statistically similar predictions of the observed steady-state lithium levels as did a model that required 12- and 36-hour levels. However, the latter two-point method produced significantly more accurate predictions from clinical interpretation. Although the two-point approach is preferable, the single-point method is clinically acceptable if its limitations of accuracy are taken into consideration.

A Long-term Retrospective Follow-up Study of Patients Treated with Prophylactic Lithium Carbonate

1987 ◽  
Vol 150 (2) ◽  
pp. 175-179 ◽  
Author(s):  
C. Page ◽  
S. Benaim ◽  
F. Lappin
Keyword(s):  
Side Effects ◽  
Complete Remission ◽  
Lithium Carbonate ◽  
Favourable Outcome ◽  
Lithium Level ◽  
Follow Up Study ◽  
High Incidence ◽  
Average Serum

Patients suffering from unipolar and bipolar affective illness, who began treatment with prophylactic lithium carbonate during a 5-year period, were followed up and 59 out of 101 interviewed. Most had been taking lithium for at least 13 years: 49% had a complete remission, 41% a partial but significant response, and 10% no response. No specific individual or illness factor was found to correlate with favourable outcome, and no correlation between average serum lithium level and outcome. No side-effects could be associated specifically with the long-term use of lithium, but there was a surprisingly high incidence of clinical hypothyroidism.

scholarly journals Polypharmacy May Be the Cause of Acute Lithium Intoxication at the Second Day of Treatment

Folia Medica ◽  
2016 ◽  
Vol 57 (3-4) ◽  
pp. 261-263 ◽  
Author(s):  
Irfan Tursun ◽  
Gokhan Tazegul ◽  
Ogur Karhan ◽  
Neslihan Gunes ◽  
Ece Ulukal ◽  
...  
Keyword(s):  
Mood Stabilizer ◽  
Therapeutic Index ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Lithium Intoxication ◽  
Lithium Level ◽  
Narrow Therapeutic Index ◽  
History Of ◽  
Acute Lithium ◽  
History Of Parkinson’S Disease

Abstract Lithium is frequently used as a mood stabilizer in patients with mood disorders. Lithium has a narrow therapeutic index and high toxicity. Predisposing factors for intoxication are advanced age, diet disturbances, comorbid medical conditions affecting heart, kidneys or central nervous system and polypharmacy. CASE REPORT: Here we present a case of a 74-year-old woman with a history of Parkinson’s disease, hypertension and bipolar disorder. She was using quetiapine, valsartan with hydrochlorothiazide and levodopa with carbidopa. She presented with altered mental status and muscle rigidity. The patient was admitted with acute lithium intoxication after her second dose of treatment. Blood lithium level increased to 3.58 mEq/L. The woman was hospitalized in the Internal Medicine Intensive Care Unit. With hydration, her symptoms resolved and her lithium level returned to normal after 118 hours. CONCLUSIONS: Prescribing physicians and emergency room physicians should be aware of conditions which may cause a decreased threshold for intoxication.

The Relationship of Plasma to Erythrocyte Lithium Levels in Patients Taking Lithium Carbonate

1975 ◽  
Vol 127 (6) ◽  
pp. 596-598 ◽  
Author(s):  
C. R. Lee ◽  
S. E. Hill ◽  
M. Dimitrakoudi ◽  
F. A. Jenner ◽  
R. J. Pollitt
Keyword(s):  
Affective Disorders ◽  
Lithium Concentration ◽  
Lithium Carbonate ◽  
Lithium Level ◽  
Plasma Ratio ◽  
Relationship Of ◽  
The Relationship

SummaryPlasma and erythrocyte lithium levels have been determined repeatedly in twelve patients taking lithium carbonate for affective disorders. In any individual the plot of the plasma lithium level against erythrocyte/plasma ratio is linear, but the ratio can either increase or decrease with increasing plasma lithium concentration. Erythrocyte/plasma ratio is an unsound basis for comparing individual responses to lithium.

scholarly journals Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting

2018 ◽  
Vol 32 (4) ◽  
pp. 408-415 ◽  
Author(s):  
Viktoriya L Nikolova ◽  
Keerati Pattanaseri ◽  
Diego Hidalgo-Mazzei ◽  
David Taylor ◽  
Allan H Young
Keyword(s):  
Thyroid Function ◽  
Secondary Care ◽  
Maintenance Phase ◽  
Clinical Excellence ◽  
Therapeutic Index ◽  
Serum Levels ◽  
Thyroid Function Tests ◽  
Lithium Level ◽  
Function Tests ◽  
Central Registry

Background: Lithium is widely used for the treatment of bipolar disorder. Owing to its narrow therapeutic index and side-effect profile, regular monitoring of serum levels, renal and thyroid function has been recommended by all major guidelines on lithium use. Objectives: We investigated whether lithium monitoring during maintenance phase treatment in clinical practice meets the latest recommendation by the National Institute for Health and Clinical excellence (i.e. lithium levels between 0.6 and 1.0 mmol/L and lithium level, thyroid and renal function tests every 6 months) in one of the largest mental health organizations in Europe, the South London and Maudsley (SLaM) NHS Foundation Trust. Methods: Retrospective data were extracted from SLaM’s Clinical Record Interactive Search (CRIS) system. Adult patients with a psychiatric disorder who were on lithium at any point during the period January 2012–January 2016 and had at least one lithium level test result in the system were included in the analyses. Results: A total of 2639 lithium level tests results were retrieved for 412 patients. Overall, the serum level was within the recommended range in 50.7% of all tests, below the range in 42.4% and above in 6.9%. Lithium level, renal and thyroid function tests were performed at the recommended frequency of 6 months (or less) in 76.2%, 72.7% and 60.2% of patients, respectively. Conclusion: These data demonstrate that there is a gap between the NICE 2014 recommendation and lithium monitoring practice in secondary care, with a high number of lithium level results below the therapeutic minimum. Reminder strategies for secondary care practitioners, shared care agreements or a central registry for lithium users could improve monitoring performance.

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