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Updated: Apr 25, 2026

The Tail Suspension Test
Published on: January 28, 2012
Lactulose-associated lithium toxicity: a case series
Andrew Bregman1, Kathy Fritz, Glen L Xiong
1From the *Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at Davis; and †Sacramento County Mental Health Treatment Center, Sacramento, CA.
Background:
Lactulose is commonly used for constipation and hepatic encephalopathy. Its adverse effects of dehydration and serum electrolyte imbalances are widely known.
Objective:
This study aimed to describe a case series of 3 patients receiving lactulose who developed lithium toxicity.
Methods:
The authors described a case series of 3 patients admitted to a large county psychiatric hospital who developed lithium toxicity while taking lactulose for constipation or hyperammonemia.
Results:
In all 3 cases of lithium toxicity, the patients were prescribed with lithium for acute mania and lactulose for constipation or hyperammonemia. One case required the patient to be transferred to a local emergency department for further treatment.
Conclusions:
This case series shows the interaction between lithium and lactulose. It is postulated that lactulose's effects of volume depletion can lead to poor renal excretion of lithium.
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