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Lithium overdose and delayed severe neurotoxicity: timing for renal replacement therapy and restarting of lithium
  1. Angharad N de Cates1,2,
  2. Julien Morlet1,
  3. Ayman Antoun Reyad3,
  4. George Tadros1,4
  1. 1RAID (Liaison Psychiatry), Birmingham Heartlands Hospital, Birmingham, UK
  2. 2Unit of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
  3. 3School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
  4. 4Aston Medical School, Aston University, Birmingham, UK
  1. Correspondence to Dr Angharad N de Cates,{at}


This is a case report of a man in his 60s who presented to an English hospital following a significant lithium overdose. He was monitored for 24 hours, and then renal replacement therapy was initiated after assessment by the renal team. As soon as the lithium level returned to normal therapeutic levels (from 4.7 mEq/L to 0.67 mEq/L), lithium was restarted by the medical team. At this point, the patient developed new slurred speech and later catatonia. In this case report, we discuss the factors that could determine which patients are at risk of neurotoxicity following lithium overdose and the appropriate decision regarding when and how to consider initiation of renal replacement therapy and restarting of lithium.

  • psychiatry (drugs and medicines)
  • poisoning
  • toxicology
  • suicide (psychiatry)
  • bipolar i disorder

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  • Contributors ANdeC, JM and GT provided clinical care for the patient. All authors devised the idea for the article. ANdeC and JM drafted the manuscript. AAR and GT revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

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