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[Diagnostic trap: Lithium neurotoxicity with normal lithemia]

Hugo Tiv1, Antoine Vandelaer1, Pierre Delanaye2

  • 1Université de Liège (ULiège), campus du Sart Tilman, 4000 Liège, Belgique.

Nephrologie & Therapeutique
|September 26, 2022
PubMed

We describe here the case of a 54-year-old bipolar woman, followed in psychiatry and treated with lithium and a selective serotonin reuptake inhibitor (escitalopram) and lamotrigine, presenting a lithium poisoning with an altered state of consciousness caused by a supposed mismanagement of her treatment. Lithium poisoning was suggested based on neurological clinical features, but the blood test brought out a lithium concentration within the therapeutic values at 1,2 mmol/L (N: 0,6-1,2 mmol/L). The classic biological complications related to lithium poisoning (hypercalcemia, diabetes insipidus) confirmed the diagnosis. The patient has been transferred to our nephrology department where she got two hemodialysis sessions conducting to clinical and biological improvement, confirming the diagnosis of lithium poisoning despite the normal blood levels. Later, she was transferred to the psychiatry department for follow-up and for treatment adjustment.

Keywords:
Bipolar disordersDiabète insipide néphrogéniqueExtrarenal epurationHypercalcemiaHypercalcémieHypernatremiaHypernatrémieLithiumNephrogenic diabetes insipidusTroubles bipolairesÉpuration extra-rénale

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