title: Lithium toxicity after Roux-en-Y bariatric surgery.
abstract: A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day. She was discharged 8 days postoperatively on the same lithium dose, but presented to the emergency department 12 days postoperatively with signs of lithium toxicity. Her lithium level was elevated to 1.51 mEq/L and she was treated for lithium toxicity with supportive care and, ultimately, reduction of her lithium dose. Clinicians should be aware that dramatic and poorly understood changes in drug absorption may occur after bariatric surgery.
authors.affiliation: Department of Critical Care Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Musfeldt
authors.affiliation: Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Levinson
authors.affiliation: Department of Emergency Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nykiel
authors.affiliation: Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Carino
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate