LITHIUM CARBONATE POISONING

A case of manic-depressive illness with sever lithium carbonate poisoning taking a long time to recovery, is reported.In this case, symptoms consisted of lethargy, fever, vomiting, tremor, lateral rotation of the head, upward gaze, conjugate lateral deviation of the eyes, anisocoria, nystagmus, muscle fasciculation, clonic contractions of large muscle groups, hyperactive tendon reflexes, Babinski sign positive, ataxia, and snout and grasp reflexes.Laboratory studies showed the following, leucocytosis and the elevated levels of serum GOT, GPT, LDH, BUN. Electroencephalograms showed generalized slowing. Cerebrospinal fluid examinations were normal.Within one month period, these acute toxic symptoms disappeared. EEG became normal after five months. The maximum serum level of lithium ion reached to 5.03 mEq / L. Twenty one days later, serum level of lithium ion was no longer presented. Six months later, a pneumoencephalogram showed slight dilatation of the lateral ventricles and widened cortical sulci in the frontal area.We also recognized mask-like facies, dysarthric, monotonous and low pitches speech, limb ataxia, dementia and change in personality. These clinical symptoms are gradually improving.In this case, in spite of lowere dosages as 400 mg/day lithium carbonate, it showed high serum lithium ion level as 5.08 mEq/L, when clinical toxic symptoms appeared.We thought, during the transition from mania to depression, the total body water was decreased, moreover the diet and liquid intake was reduced, in consequence serum lithium ion level increased and severe intoxication appeared.Prevention of intoxication required administration of proper dosage and maintaining laboratory and clinical control during treatment.