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Lithium toxicity arrives due to a possible drug-drug interaction: a case report

Author: 
Dr. Nehal R. Parikh, Dr. Harsha Makwana, Dr. Shikha V. Sood, Dr. Supriya D. Malhotra and Dr. Pankaj Patel
Subject Area: 
Health Sciences
Abstract: 

Bipolar disorder (BPD) is a serious mental disorder characterized by episodes of depression, hypomania/mania and mixed episodes, with inter episodic recovery. For over 60 years, lithium carbonate has been used as first-line therapy for the treatment of bipolar disorder as mood-stabilizing drugs. Lithium is probably more effective in preventing mania than depression, and reduces the risk of suicide in people with BPD. Neurological disturbances caused by lithium range from simple side effects to acute neurotoxicity. Here we have reported case report of A 57-year-old Hypertensive female presented to the emergency department with lithium toxicity. This adverse drug reaction (ADR) after excluding other causative factors was categorized under “ Probable” category and reported via vigiflow. All the medications were stopped immediately and she was then subjected to two sessions of hemodialysis. She was also given IV fluid hydration with normal saline. On discharge she was conscious and psychologically stable. Being vigilant for the early signs and symptoms of lithium toxicity can help in early diagnosis and prompt treatment. Narrow therapeutic index remains a major limitation of lithium treatment as it requires close monitoring and identification of neurologic adverse events.In clinical practice it has been observed that valproate is replacing lithium for elderly patients with bipolar disorder because valproic acid offers comparable efficacy, and the advantage of greater safety.

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