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Lithium Intoxication in an Elderly Woman.

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Summary

Elderly patients with polypharmacy are at risk of lithium toxicity, presenting with delirium and acute kidney injury. Prompt diagnosis and management are crucial to prevent irreversible neurological damage.

Keywords:
acute confusional stateacute kidney injurydeliriumlithium intoxicationlithium toxicity

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Area of Science:

  • Geriatrics
  • Clinical Pharmacology
  • Emergency Medicine

Background:

  • Delirium in the elderly often requires extensive differential diagnosis in the emergency room.
  • Iatrogenic causes, particularly polypharmacy, are significant contributors to delirium in older adults.
  • Lithium, a mood stabilizer, has a narrow therapeutic index and can cause toxicity, especially in the elderly.

Observation:

  • A 77-year-old female with hypertension, dyslipidemia, and bipolar disorder presented with delirium, vomiting, and acute kidney injury.
  • Initial diagnosis was acute gastroenteritis and prerenal acute kidney injury; however, symptoms worsened.
  • A lithium blood level test revealed toxic levels (2.18 mmol/L), prompting intervention.

Findings:

  • Lithium toxicity can manifest with gastrointestinal and neurological symptoms, often correlating with chronic toxicity.
  • Reduced renal function and altered body composition in the elderly increase susceptibility to lithium toxicity.
  • Dehydration, potentially triggered by vomiting and diarrhea, may exacerbate lithium toxicity.

Implications:

  • Careful review of chronic medications and thorough etiological investigation are essential for managing delirium in elderly patients.
  • Early recognition of lithium toxicity is critical to prevent severe complications and irreversible neurological damage.
  • This case highlights the importance of considering iatrogenic causes, including medication toxicity, in the differential diagnosis of delirium in older adults.