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Psychosomatic Medicine 61:564-565 (1999)
© 1999 American Psychosomatic Society

CASE REPORT

Elevated Lithium Level: A Case and Brief Overview of Lithium Poisoning

Sean Patrick Nordt, PharmD and F. Lee Cantrell, PharmD

From the California Poison Control System San Diego, Division of Medical Toxicology, University of California, San Diego, San Diego, CA.

Address reprint requests to: Sean Patrick Nordt, PharmD, ABAT, California Poison Control System San Diego, Division of Medical Toxicology, University of California, San Diego, 200 West Arbor Dr., San Diego, CA 92103-8925. Email: snordt{at}ucsd.edu

ABSTRACT

INTRODUCTION: We present the case of a minimally symptomatic patient found to have an elevated lithium level after a blood sample was inadvertently obtained in a green-top tube containing lithium heparin.

CASE REPORT: A 33-year-old woman presented 8 hours after ingesting an unknown quantity of sustained-release lithium carbonate, venlafaxine, clonazepam, and valproic acid. The patient was noted to be slightly drowsy but could be easily aroused. No gastrointestinal symptoms or electrocardiographic changes were observed. The patient was admitted to the intensive care unit for observation. The patient’s lithium level 21 hours after ingestion was 5.6 mEq/liter, but she was clinically asymptomatic. The disagreement between symptoms and lithium level led to the discovery that this blood sample had been collected in a lithium heparin tube, thereby falsely elevating the level.

CONCLUSIONS: This case illustrates the wisdom of the old adage to "treat the patient, not the levels." Caution should be used by physicians, nurses, technicians, and other personnel when obtaining blood samples.

Key Words: lithium • poisoning • laboratory error






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Copyright © 1999 by the American Psychosomatic Society