Hypercalcemia and Nephrogenic Diabetes Insipidus: Rare and Life-Threatening Effects of Lithium Intoxication

Arturo de Falco, Maria Lieto, Valentina Scarano, Daniele Spitaleri, Vincenzo Palma

DOI: https://doi.org/10.7175/cmi.v14i1.1461

Abstract

Lithium is the most effective therapy for bipolar and schizoaffective disorders. Despite its efficacy, lithium has a narrow therapeutic index and adverse effects are frequent. Lithium intoxication (LI) generally affects brain, but less frequently can affect kidneys, thyroid, and parathyroid.

Here, we report the case of a patient with lithium neurotoxic effects complicated by parathyroid and renal adverse effects. The patient was a 52-year-old woman treated with lithium, who was recently diagnosed with hypercalcemia and hyperparathyroidism.

She was admitted for severe agitation, confusion, and diffuse tremor. Despite serum lithium and calcium normalization, laboratory tests revealed a life-threatening hypernatremia caused by nephrogenic diabetes insipidus (NDI). Hemodialysis was started, but after the first treatment the patient died for cardiac arrest.

Neurological symptoms of LI may occur even if the dosage is close to the normal therapeutic range. Hypercalcemia and NDI are rare, but should be promptly diagnosed and treated. In case of poor clinical outcome, hemodialysis should be performed independently of lithium serum level.

Keywords

Lithium Toxicity; Hypercalcemia; Nephrogenic Diabetes Insipidus; Hypernatremia

Full Text

HTML PDF

References

  • Oruch M, Elderbi MA, Khattab HA, et al. Lithium: a review of pharmacology, clinical uses, and toxicity. Eur J Pharmacol 2014; 740: 464-73; https://doi.org/10.1016/j.ejphar.2014.06.042
  • Ott M, Stegmayr B, Salander Renberg E, et al. Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study. J Psychopharmacol 2016; 30: 1008-19; https://doi.org/10.1177/0269881116652577
  • Baird-Gunning J, Lea-Henry T, Hoegberg LCG, et al. Lithium Poisoning. J Intensive Care Med 2017; 32: 249-63; https://doi.org/10.1177/0885066616651582
  • McKnight RF, Adida M, Budge K, et al. Lithium toxicity profile: a systematic review and meta-analysis. Lancet 2012; 379: 721-8; https://doi.org/10.1016/S0140-6736(11)61516-X
  • Shine B, McKnight RF, Leaver L, et al. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet 2015; 386: 461-8; https://doi.org/10.1016/S0140-6736(14)61842-0
  • Erden A, Karagöz H, Başak M, et al. Lithium intoxication and nephrogenic diabetes insipidus: a case report and review of literature. Int J Gen Med 2013; 6: 535-9; https://doi.org/10.2147/IJGM.S46383
  • Ott M, Forssen B, Werneke U. Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study. Ther Adv Psychopharmacol 2019; 9: 2045125319836563; https://doi.org/10.1177/2045125319836563
  • Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab 2009; 23: 723-33; https://doi.org/10.1016/j.beem.2009.06.002
  • Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? J Affect Disord 2013; 146: 151-7; https://doi.org/10.1016/j.jad.2012.08.028
  • Shapiro HI, Davis KA. Hypercalcemia and “primary” hyperparathyroidism during lithium therapy. Am J Psychiatry 2015; 172: 12-5; https://doi.org/10.1176/appi.ajp.2013.13081057
  • Kayrak M, Duman C, Gul EE, et al. A bizarre electrocardiographic pattern due to chronic lithium therapy. Ann Noninvasive Electrocardiol 2010; 15: 289-92; https://doi.org/10.1111/j.1542-474X.2010.00366.x
  • Haussmann R, Bauer M, von Bonin S, et al. Treatment of lithium intoxication: facing the need for evidence. Int J Bipolar Disord 2015; 3: 23; https://doi.org/10.1186/s40345-015-0040-2
  • Decker BS, Goldfarb DS, Dargan PI, et al. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol 2015; 10: 875-87; https://doi.org/10.2215/CJN.10021014
  • Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28: 38-49; https://doi.org/10.1097/01.wnf.0000150871.52253.b7

Statistics

Abstract: 698 views
HTML: 1695 views
PDF: 305 views

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.