title: Lithium intoxication-induced acute parkinsonism complicated with hyperparathyroidism and nephrogenic diabetes insipidus: report of a case.
abstract: OBJECTIVE
  To describe a patient with lithium intoxication presenting as acute parkinsonism, adverse metabolic effects and nephrogenic diabetes insipidus (DI).
  
  
  METHODS
  We report a case of a 67-year-old woman with a bipolar affective disorder who was treated with lithium for 10 years. Under concomitant renal insufficiency and urinary tract infarction, she experienced progressive hand tremor, bradykinesia, and unsteady gait. Laboratory results revealed hypercalcemia and hypermagnesiemia. A high serum lithium level (3.6 mEq/L) was found; thus lithium was discontinued. She was found to have a high serum level of intact parathyroid hormone: 135.0 pg/ml and a suspicious parathyroid adenoma. Polyuria with hypernatremia was also noted. A water deprivation test confirmed nephrogenic diabetes insipitces. After correction of electrolyte imbalance and reduction of lithium level, her consciousness recovered. Her parkinsonian features were responsive to levodopa 400 mg/day in 2 divided doses. One month later, apart from the residual extrapyramidal symptoms and mania, her condition was otherwise stationary.
  
  
  CONCLUSIONS
  Tremor is the most frequent movement disorder associated with lithium therapy, while severe parkinsonism has been rarely reported. It should be kept in mind in differential diagnosis of acute parkinsonism especially in elder patients who receive a chronic lithium carbonate therapy.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
authors.forename: Hsiu-Chu
authors.initials: HC
authors.lastname: Shen
authors.forename: Jie-Yuan
authors.initials: JY
authors.lastname: Li
authors.forename: Yuk-Keung
authors.initials: YK
authors.lastname: Lo
mesh_terms: D000208:Acute Disease; D000368:Aged; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000139:chemically induced*; D016651:Lithium Carbonate / Q000506:poisoning*; D020734:Parkinsonian Disorders / Q000139:chemically induced*
chemical_list: D016651:Lithium Carbonate