title: Unrecognized delayed toxic lithium peak concentration in an acute poisoning with sustained release lithium product.
abstract: A 32-year-old female with a history of bipolar disorder was admitted after taking approximately 16 g of an extended-release lithium carbonate formulation in an attempted suicide. Five hours after consumption, the lithium serum level was 3.2 mEq/L. Fourteen hours after consumption, the lithium level was 5.1 mEq/L and the patient was asymptomatic. Due to a level > 4 mEq/L, the patient was transferred to a renal medicine service for hemodialysis. The lithium concentration 6 hours after the hemodialysis was 2.54 mEq/L. Thirty seven hours after the consumption (15 hours after hemodialysis), lithium levels increased up to 6.09 mEq/L. A second hemodialysis session was performed, which successfully reduced the serum lithium concentration to 1.86 mEq/L. Lithium levels 85 hours after the consumption were 0.61 mEq/L and the patient was transferred to the Psychiatry Department. Unrecognized delayed toxic peak lithium concentration may appear in an acute poisoning with a sustained release lithium product. Therefore, patients presenting with acute intoxication with extended release formulations should be managed with caution, and continued drug monitoring is suggested.
authors.affiliation: Pharmacy Department, Hospital de Sagunto, Avda Ramon y Cajal s/n, Sagunto 46520, Valencia, Spain. jborrasb@sefh.es
authors.forename: Joaquín
authors.initials: J
authors.lastname: Borrás-Blasco
authors.forename: Ana Esther
authors.initials: AE
authors.lastname: Sirvent
authors.forename: Andrés
authors.initials: A
authors.lastname: Navarro-Ruiz
authors.forename: Ana
authors.initials: A
authors.lastname: Murcia-López
authors.forename: Isabel
authors.initials: I
authors.lastname: Romero-Crespo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Enriquez
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000097:blood / Q000506:poisoning*; D001714:Bipolar Disorder / Q000188:drug therapy; D003692:Delayed-Action Preparations; D062787:Drug Overdose; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000097:blood / Q000506:poisoning*; D012008:Recurrence; D006435:Renal Dialysis; D019233:Retreatment; D016060:Sorption Detoxification; D013406:Suicide, Attempted
chemical_list: D018692:Antimanic Agents; D003692:Delayed-Action Preparations; D016651:Lithium Carbonate