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Do not treat the numbers: lithium toxicity
  1. Peter Foulser,
  2. Yasmin Abbasi,
  3. Anand Mathilakath,
  4. Ramin Nilforooshan
  1. Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, UK
  1. Correspondence to Dr Peter Foulser, pfgfoulser{at}


We describe the case of a 62-year-old man with a history of bipolar disorder, previously stable on lithium for over 20 years, who presented with a manic relapse and signs of lithium toxicity in the form of a coarse tremor. Serum lithium levels were in the normal range, and the patient had stage 3 chronic kidney disease. He was admitted for treatment under Section 2 of the Mental Health Act, and after stopping lithium was started on olanzapine. Signs of lithium toxicity improved after withdrawal of lithium. This case highlights the need to treat normal serum lithium levels with caution in patients showing signs of clinical lithium toxicity.

  • Psychiatry (drugs and medicines)
  • Contraindications and precautions
  • Drugs: psychiatry
  • Bipolar I disorder

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  • Contributors PF wrote the article and conducted literature review, sending it for review to the other authors. He also collated information from the patient's notes. YA helped with the written content and editing of the article, and also assisted with the literature review. She also researched the patient's prognosis and long-term follow-up. AM was involved in the initial planning of the article. RN gave advice regarding the content and direction of the article, particularly the discussion. He edited the article and reviewed the article prior to submission. PF and YA are guarantors for the content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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