A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment

Hye-Sang Ohm; Hyoungyoung Kim; Seong Hoon Han; Bongseog Kim

doi:10.4306/jknpa.2014.53.6.434

Journal List > J Korean Neuropsychiatr Assoc > v.53(6) > 1017710

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Ohm, Kim, Han, and Kim: A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment

Case Report

Journal of Korean Neuropsychiatric Association 2014; 53(6): 434-437.

Published online: 30 November 2014

DOI: https://doi.org/10.4306/jknpa.2014.53.6.434

A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment

Hye-Sang Ohm, MD¹, Hyoungyoung Kim, MD², Seong Hoon Han, MD, PhD², Bongseog Kim, MD, PhD¹

¹Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

²Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Address for correspondence: Bongseog Kim, MD, PhD. Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. Tel +82-2-950-1087, Fax +82-2-936-8069, kimbs328@paik.ac.kr

Received 15 September 2014 Revised 21 October 2014 Accepted 27 October 2014

Abstract

Lithium is a widely used drug for treatment of bipolar disorder. Because of its narrow therapeutic range and renal toxicity, most clinical guidelines recommend regular monitoring of serum lithium level and kidney function for patients taking lithium. We report on a case of a 20 year-old man with occurrence of lithium toxicity after more than one year of lithium maintenance therapy with daily lithium intake of 900 mg. His serum creatinine level was within normal range at admission and elevated compared to his baseline, but still within normal range when lithium toxicity occurred. Acute kidney injury associated with dehydration, analgesics, and nephrotoxic effect of lithium might be a risk factor of lithium toxicity. This case showed the importance of thorough monitoring of serum creatinine level change even if its elevated result is within normal range in observing renal function of patients treated with lithium.

Keywords: Lithium toxicity, Creatinine, Bipolar affective disorder, Non-steroidal anti-inflammatory agents

Figures and Tables

Fig. 1

Serum lithium, BUN, creatinine concentration. BUN : Blood urea nitrogen.

Table 1

Laboratory findings on admission

Notes

The authors have no financial conflicts of interest.

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