February 2021: Clinical Presentation Provides Clue to Toxicity

A 43-year-old man with a history of bipolar disorder, hypertension, and asthma presented with altered mental status and a tremor. He reported increasing fatigue and hand tremors for one day. He said he and his family recently had food poisoning with vomiting and diarrhea for several days. Those symptoms had resolved. He continued to take all of his prescribed medications, which included lithium carbonate (Lithobid) 800 mg BID and amlodipine 10 mg daily.His initial vital signs were a heart rate of 104 bpm, a blood pressure of 136/82 mm Hg, a respiratory rate of 16 bpm, an oxygen saturation of 99% on room air, and a temperature of 98.9°F. His neurologic exam was significant for somnolence and a fine tremor of his hands. He was mildly tachycardic. His lungs were clear. No other significant findings were noted.His lab results were significant for a lithium level of 2.4 mEq/L, a creatinine of 1.7 mg/dL (his baseline creatinine was 0.84 mg/dL), and a WBC count of 15. TSH and other laboratory tests were otherwise unremarkable. His last dose of lithium was taken approximately 10 hours prior to his arrival in the ED.Pharmacokinetics of LithiumPeak concentrations of immediate-release lithium occur within one to two hours while sustained-release formulations may peak at four to five hours. Large ingestions of lithium carbonate can form concretions in the stomach and therefore delay symptoms by up to 48 hours after ingestion.Lithium initially distributes in the intravascular space and u...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs