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Related Concept Videos

Mania and Antimanic Drugs: Overview01:24

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Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
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Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
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Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
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Related Experiment Video

Updated: Mar 1, 2026

A Protocol for Safe Lithiation Reactions Using Organolithium Reagents
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Do not treat the numbers: lithium toxicity.

Peter Foulser1, Yasmin Abbasi1, Anand Mathilakath1

  • 1Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, UK.

BMJ Case Reports
|June 4, 2017
PubMed
Summary

This case study shows that even normal serum lithium levels can indicate toxicity in patients with chronic kidney disease and bipolar disorder. Careful clinical assessment is crucial for managing lithium treatment safely.

Keywords:
Bipolar I disorderContraindications and precautionsDrugs: psychiatryPsychiatry (drugs and medicines)

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Nephrology

Background:

  • Bipolar disorder management often involves lithium therapy.
  • Lithium is effective but requires careful monitoring due to its narrow therapeutic index.
  • Chronic kidney disease (CKD) can affect lithium pharmacokinetics and increase toxicity risk.

Observation:

  • A 62-year-old male with bipolar disorder on long-term lithium presented with manic relapse and tremor.
  • Serum lithium levels were within the normal range.
  • The patient had stage 3 chronic kidney disease.

Findings:

  • Clinical signs suggested lithium toxicity despite normal serum levels.
  • Lithium withdrawal led to improvement in toxicity symptoms.
  • This indicates potential for lithium toxicity at normal levels in CKD patients.

Implications:

  • Clinicians must consider clinical signs of lithium toxicity over serum levels in patients with CKD.
  • Individualized lithium dosing and monitoring are essential, especially in renal impairment.
  • This case underscores the importance of integrating renal function into lithium management protocols.