The perfect cycle for a lithium overdose

Marta M. Morell-Castro, Pulmonary & Critical Care Service, Veterans Hospital San Juan, San Juan, Puerto Rico
Stephanie Rivera-Rivera, Critical Care Service, Veterans Hospital San Juan, San Juan, Puerto Rico
Ilia Velez-Rodriguez, Pulmonary & Critical Care Service; Research Fellow; Veterans Hospital San Juan, San Juan, Puerto Rico
William Rodríguez-Cintrón, Pulmonary & Critical Care Service; Pulmonary & Critical Care Service Chief. Veterans Hospital San Juan, San Juan, Puerto Rico

Lithium is a medication mainly used to treated bipolar disorder. Lithium can have many drugs interaction including thiazide diuretics, non-steroidal anti-inflammatory drugs (NSAIDS) and selective serotonin reuptake inhibitors (SSRIs) leading to decreased lithium clearance. Supratherapeutic levels can cause toxicity and manifest as neurological symptoms. High clinical suspicion is required for prompt treatment to avoid long term sequela and even death. This is a case of a 57 year old male presented with ataxia, dysarthria with poor oral intake and laboratories remarkable for supratherapeutic lithium levels; an aftermath of NSAIDs use in which a parallel infectious process lead to volume depletion and renal failure causing acute lithium toxicity.

Keywords: Lithium toxicity. Bipolar disorder. Chronic lithium toxicity. Volume depletion. Drug interactions.