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A Case Report and Review of the Literature

Marie Simard, MD; Barry Gumbiner, MD; Alexander Lee, MD; Howard Lewis, MD; Dean Norman, MD

Arch Intern Med. 1989;149(1):36-46.

Abstract
• Lithium carbonate is a widely used and invaluable drug in the treatment and prevention of manic-depressive illness. However, this medication has a low therapeutic index and, therefore, many attendant side effects. Acute lithium carbonate intoxication affects predominantly the central nervous system and the renal system and is potentially lethal. We studied a case of acute lithium carbonate intoxication characterized by a prolonged comatose state, severe nephrogenic diabetes insipidus, and glucose intolerance. Of interest, the patient's symptoms and signs of toxic reaction developed after normalization of the plasma lithium ion levels. We reviewed the multisystemic toxic effects of lithium carbonate as well as its teratogenic potential and guidelines for its use during pregnancy. The management of acute lithium carbonate intoxication should include hydration with normal saline, intensive care monitoring, and dialysis if indicated.

(Arch Intern Med 1989;149:36-46)

Author Affiliations
From the Department of Medicine, Veterans Administration Medical Center West Los Angeles (Wadsworth Division), and UCLA School of Medicine. Dr Gumbiner is now with the Veterans Administration Medical Center, San Diego.

Footnotes
Accepted for publication May 3, 1988.

Reprint requests to 691/W11G, Division of Geriatrics, Department of Medicine, VAMC West Los Angeles, Los Angeles, CA 90073 (Dr Norman).

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