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Old 03-05-2013
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Default cause of Lithium toxicity

A 38 year old woman with manic depressive illness is evaluated in the emergency department for slurred speech and severe fatigue of one day duration. She also has nausea and vomiting since morning. She denies any recent fever. She has been on Lithium Carbonate for the past 3 months and her level was therapeutic 1 month ago. She is a very compliant patient and denies overdosing herself with lithium. Her past medical history is significant for hypertension for which she was started on combination of Hydrochlorthiazide and Enalapril one week ago. She does report “salt craving” for past few days and has been taking excessive amount dietary salt though she is aware that it is not good for blood pressure. Physical examination reveals coarse tremors and fasciculations. Laboratory investigations reveal slightly increased serum creatinine at 1.2mg%. Her baseline creatinine is 1.0mg%. Today, the Lithium level is 3.0 mmol/L. Which of the following is responsible for acute lithium toxicity in this patient?

A) Acute renal failure

B) Drug interaction

C) Increased absorption

D) Excess Salt intake

E) Intentional overdose
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Old 03-05-2013
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Default A) Acute renal failure

A) Acute renal failure
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Old 03-05-2013
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Default Answer is B

Answer is B) Drug interaction, because there are some drugs increase Lithium:

1. Thiazide diuretics
2. NSAIDs
3. ACE-inhibitors
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Old 03-05-2013
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Default

its not a drug interaction but simply because Lithium is reabsorbed along with sodium as the body is trying to salvage fluid and sodium lost by using thiazide diuretics
Ans is C....
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