The clinical manifestations of lithium intoxication

Background: Lithium has been a part of the psychiatric pharmacopoeia for more than half a century. Its efficacy is marred by a narrow therapeutic index and significant toxicity. Objectives: To increase physicians' awareness of the various manifestations of lithium intoxication. Methods: We reviewed the clinical data of cases of lithium poisoning occurring in a municipal hospital during a 10 year period. Results: Eight patient records were located. The mortality rate was 12.5%. All patients were women and the mean age was 66.4 years. The most common symptoms were neurologic. One illustrative case is described in detail with lithium serum levels showing the usual two-phase decline. Conclusions: Lithium poisoning can present in many forms. Increased physician awareness and the early use of effective treatment, mainly hemodialysis, will prevent mortality and protracted morbidity associated with this condition.