title: Polypharmacy May Be the Cause of Acute Lithium Intoxication at the Second Day of Treatment.
abstract: Lithium is frequently used as a mood stabilizer in patients with mood disorders. Lithium has a narrow therapeutic index and high toxicity. Predisposing factors for intoxication are advanced age, diet disturbances, comorbid medical conditions affecting heart, kidneys or central nervous system and polypharmacy.
  
  
  
  Here we present a case of a 74-year-old woman with a history of Parkinson's disease, hypertension and bipolar disorder. She was using quetiapine, valsartan with hydrochlorothiazide and levodopa with carbidopa. She presented with altered mental status and muscle rigidity. The patient was admitted with acute lithium intoxication after her second dose of treatment. Blood lithium level increased to 3.58 mEq/L. The woman was hospitalized in the Internal Medicine Intensive Care Unit. With hydration, her symptoms resolved and her lithium level returned to normal after 118 hours.
  
  
  
  Prescribing physicians and emergency room physicians should be aware of conditions which may cause a decreased threshold for intoxication.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Irfan
authors.initials: I
authors.lastname: Tursun
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tazegul
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Ogur
authors.initials: O
authors.lastname: Karhan
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Neslihan
authors.initials: N
authors.lastname: Gunes
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Ece
authors.initials: E
authors.lastname: Ulukal
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Muge Arpali
authors.initials: MA
authors.lastname: Atcakarlar
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Tolgahan
authors.initials: T
authors.lastname: Akca
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
authors.forename: Erkan
authors.initials: E
authors.lastname: Coban
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D008094:Lithium / Q000009:adverse effects* / Q000032:analysis* / Q000627:therapeutic use; D010300:Parkinson Disease; D019338:Polypharmacy
chemical_list: D000928:Antidepressive Agents; D008094:Lithium