A 65-year-old female presented with only gastrointestinal symptoms eight to ten hours after an acute ingestion of an unknown amount of lithium carbonate. The serum lithium concentration was 8.5 mEq/L. Forty-eight hours postingestion she developed acute renal failure, deteriorating mental status, and cardiovascular collapse. Despite both hemodialysis and peritoneal dialysis the patient died approximately four and one-half days after ingestion. A direct nephrotoxic effect of lithium is proposed.
Get full access to this article
View all access options for this article.
References
1.
CORCORANAC, TAYLORRD, PAGEIH. Lithium poisoning from the use of salt substitutes. JAMA1949; 139: 685–8.
2.
HANLONLW, ROMAINEM, GILROYFJ, DEITRICKJE. Lithium chloride as a substitute for sodium chloride in the diet. JAMA1949; 139: 688–92.
3.
HANSENHE, AMDISENA.Lithium intoxication (report of 23 cases and review of 100 cases from the literature). Q J Med1978; 47: 123–44.
4.
HANSENHE. Renal toxicity of lithium. Drugs1981; 22: 461–76.
5.
SCHOUM, AMDISENA, TRAP-JENSENJ.Lithium poisoning. Am J Psychiatry1968; 125: 112–9.
6.
PERRYPJ. Lithium nephrotoxicity. Drug Intell Clin Pharm1982; 16: 740–4.
7.
SINGERI.Lithium and the kidney. Kidney Int1981; 19: 374–87.
8.
MYERSJB, MORGANTO, CARNEYSL, RAYC.Effects of lithium on the kidney. Kidney Int1980; 18: 601–8.
9.
LAVENDERS, BROWNJN, BERRILLWT. Acute renal failure and lithium intoxication. Postgrad Med J1973; 49; 277–9.
10.
BEARRA, SUGARL, PAULM.Nephrotic syndrome and renal failure secondary to lithium carbonate therapy. Can Med Assoc J1985; 132: 735–6.
11.
DE PAULOJR, CORREAEI, SAPIRDG. Renal toxicity of lithium and its implications. Johns Hopkins Med J1981; 149: 15–21.
12.
CHAPMANAJ, LEWISG.Iatrogenic lithium poisoning: a case report with necropsy findings. Oklahoma State Med Assoc J1972; 65: 491–4.
13.
HWANGS, TUASONVB. Long-term maintenance lithium therapy and possible irreversible renal damage. J Clin Psychiatry1980; 41: 11–9.
14.
THOMSENK, OLESENOV. Precipitating factors and renal mechanisms in lithium intoxication. Gen Pharmacol1978; 9: 85–9.
15.
HESTBECHJ, HANSENHE, AMDISENA, OLSENS.Chronic renal lesions following long-term treatment with lithium. Kidney Int1977; 12: 205–13.
16.
FENVESAZ, EMMETTM, WHITEMG. Lithium intoxication associated with acute renal failure. South Med J1984; 77: 1472–4.
17.
AMDISENA, SKJOLDBORGH.Hemodialysis for lithium poisoning (letter). Lancet1969; 2: 213.
UNGERJ, DECAUXG, L'HERMITEM.Rhabdomyolysis, acute renal failure, endocrine alterations and neurological sequelae in a case of lithium self poisoning. Acta Clin Belg1982; 37: 216–23.
21.
VONHARTITZSCHB, HOENICHNA, LEIGHRJ, etal. Permanent neurological sequelae despite haemodialysis for lithium intoxication. Br Med J1972; 4: 757–9.
22.
ACHONGMR, FERNANDEZPG, MCLEODPJ. Fatal self-poisoning with lithium carbonate. Can Med Assoc J1975; 112: 868–70.
