THE LITHIUM TOXIC PATIENT IN THE MEDICAL HOSPITAL - DIAGNOSTIC AND MANAGEMENT DILEMMAS

Objective: Patients with lithium toxicity can pose difficulties in dia gnosis and management in the general hospital setting. The authors exa mined patients who were referred to the Psychiatric Consultation-Liais on Service with suspicion of lithium overdose to delineate and charact erize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity. Method: The authors revie wed the charts of patients with lithium levels >1.5 mEq/L who were adm itted consecutively to a general hospital over an 18-month period. Res ults: Of twelve patients, eight were found to have developed lithium t oxicity due to incidental and iatrogenic factors. These patients prese nted with a variety of confusing signs and symptoms. Hypothyroidism an d coexisting organic illness contributed to the lack of clarity in the ir clinical picture. Conclusion: The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which chall enge the diagnostic skills of the consulting psychiatrist in a general hospital setting.