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The Tail Suspension Test

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Chronic Lithium Intoxication: A Challenging Diagnosis.

Sofia Ferreira¹, Sara Santos², Sérgio Gomes Ferreira¹

¹Internal Medicine, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT.

|February 20, 2024

Summary

Chronic lithium intoxication can cause serious health issues, especially with dehydration. This case shows that careful monitoring is crucial to prevent severe multisystem dysfunction, even when diagnosis is delayed.

Keywords:

bipolar disorder chronic renal insufficiency diabetes insipidus nephrogenic lithium carbonate toxicity

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Area of Science:

Clinical Medicine
Pharmacology
Nephrology

Background:

Lithium, a mood stabilizer since the 1970s, is vital for bipolar disorder treatment.
Its narrow therapeutic index frequently leads to toxicity, particularly with chronic use and dehydration.
Documented effects include nervous, renal, cardiac, thyroid, and parathyroid system dysfunction.

Observation:

A 66-year-old woman with schizoaffective psychosis and chronic kidney disease presented with altered mental status and dysarthria.
Despite prior recommendations to stop lithium over a year ago, she continued its use.
This resulted in neurological, cardiac, renal, and endocrine complications.

Findings:

The patient exhibited multisystem dysfunction due to chronic lithium intoxication.
Diagnosis was delayed, but the patient's condition improved without requiring renal replacement therapy.
This case underscores the risks of unmonitored lithium use.

Implications:

Highlights the critical need for diligent patient history and monitoring in lithium therapy.
Emphasizes diagnostic challenges in identifying lithium toxicity.
Reinforces the potential for severe, widespread health consequences from improper lithium management.