SHM Converge Scientific Abstract ePoster Gallery-A Pressing Case of Lithium Toxicity

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This case report describes a 15-year-old boy with depressive and schizoaffective disorders who was admitted for acute lithium toxicity after several days of malaise, nausea, vomiting, tremors, and difficulty walking. His outpatient lithium level was 3.3, and the initial concern was overdose or medication error. During hospitalization, he developed severe hypertension, respiratory distress from fluid overload, and evidence of renal injury, including hematuria and proteinuria. He required transfer to the PICU for nicardipine infusion and BiPAP support.<br /><br />Further history revealed that he had had streptococcal pharyngitis three weeks earlier. Laboratory testing showed low C3, normal C4, and elevated ASO and DNase B titers, consistent with post-streptococcal glomerulonephritis (PSGN). The renal impairment from PSGN likely reduced lithium clearance and caused the toxicity.<br /><br />The patient improved with supportive care and was discharged with outpatient blood pressure management. The report emphasizes that lithium has a narrow therapeutic range and toxicity can occur from overdose, drug interactions, dehydration, or renal dysfunction. It also highlights PSGN as a cause of hypertension, fluid retention, and nephritic urine findings in children, usually resolving within weeks with good overall prognosis.<br /><br />The main takeaway is that in patients with acute lithium toxicity, especially those with psychiatric histories, clinicians should not assume overdose alone. A careful, repeated history and thorough evaluation for renal causes such as PSGN are essential when the cause is unclear.

Asset Subtitle

Valentina Bonnefil

Meta Tag

Author List Nathan Money, Valentina Bonnefil

Category Clinical Vignettes

Concept Lithium Toxicity

Concept Post-Infectious Glomerulonephritis

Concept Renal Dysfunction

Concept Hypertension

Concept Hematuria

Distinguished Non-Finalist

Presenter Organization Rocky Vista College of Osteopathic Medicine

Presenting Author Valentina Bonnefil

Track Pediatric

Keywords

lithium toxicity

post-streptococcal glomerulonephritis

renal impairment

adolescent psychiatry

hypertension

fluid overload

hematuria

proteinuria

streptococcal pharyngitis

acute kidney injury

Lithium Toxicity

Post-Infectious Glomerulonephritis

Renal Dysfunction

Hypertension

Hematuria