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

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

Authors

  • Arturo de Falco Neurology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Italy https://orcid.org/0000-0002-5944-2984
  • Maria Lieto Neurology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Italy
  • Valentina Scarano Neurology and Stroke Unit, A.O.R.N. San G. Moscati, Avellino
  • Daniele Spitaleri Neurology and Stroke Unit, A.O.R.N. San G. Moscati, Avellino
  • Vincenzo Palma Neurology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Italy

DOI:

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

Keywords:

Lithium Toxicity, Hypercalcemia, Nephrogenic Diabetes Insipidus, Hypernatremia

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.

References

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Published

2020-09-30

Issue

Vol. 14 No. 1 (2020)

Section

Case report

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