Lithium toxicity presenting as mania

Acute lithium toxicity generally presents with a change in mental status, usually seen as lethargy progressing to coma as poisoning becomes more severe. We discuss three patients who presented with mild lithium toxicity. In two patients the presentation mimicked mania, but the third presented with a more typical toxic confusion state. Improvement in all cases paralleled the drop in serum lithium levels. This uncommon presentation of lithium toxicity is not adequately stressed in the literature.