Severe, protracted lithium intoxication with delayed serum surge after 5 days of low‐dose exposure: A case report

Abstract

Lithium is a cornerstone pharmacotherapy for bipolar disorders; however, its narrow therapeutic index complicates clinical management. 1 We pre-sent an unusual case of severe, protracted lithium intoxication after only 5 days of low-dose exposure, characterized by a delayed serum surge 10 days post-discontinuation and marked post-hemodialysis rebound. This case illustrates how pharmacokinetic vulnerability may precipitate life-threatening toxicity even in the absence of classic risk factors. As the patient died 131 days after resolution of lithium intoxication, with no clinical evidence suggesting a direct relationship with the intoxication (Supplementary Information), written informed consent for publication was obtained from his next of kin. A 49-year-old man with schizoaffective disorder was admitted for a manic episode with psychotic features. Despite 9 years of psychiatric care, he was lithium-naïve. He had well-controlled diabetes mellitus (admission HbA1c, 5.9%), no known renal disease, and no preadmission use of diuretics, antihypertensives, or nonsteroidal anti-in fl ammatory drugs. Alongside