2026 Volume 59 Issue 9 Pages 528-533
A 40‒year‒old male with a history of bipolar disorder, was undergoing psychiatric care. His last recorded blood lithium level was 0.9 mEq/L two years prior. He presented with impaired consciousness following transportation to our hospital. CT showed high‒density areas in the stomach, raising the suspicion of an overdose. Given that his regular medications included lithium carbonate, we considered the possibility of acute lithium toxicity. Following gastric lavage, we urgently admitted him to HCU. After admission, his impaired consciousness persisted, and the subsequent morning he experienced generalized convulsions. His lithium level at the time of admission was 4.23 mEq/L, being within the toxic range. Due to decreased urine output and respiratory instability, we initiated ventilatory support and selected hemodialysis (HD). Convulsions were observed even during HD sessions. HD was conducted daily for three consecutive days, and on the fifth day of admission, the post‒dialysis lithium level had decreased to 0.76 mEq/L, allowing HD to be discontinued. Extubation was performed on the same day. The patient then remained convulsion‒free and was discharged home on the 15th day of hospitalization. This was a patient with acute lithium toxicity successfully managed with HD. The serum lithium concentration on admission was 4.23 mEq/L, exceeding the lethal threshold (4.0 mEq/L), yet daily HD resulted in improved consciousness and convulsion control. This case suggests that, in patients with acute lithium poisoning presenting with severe central nervous system symptoms, HD can rapidly reduce lithium levels and improve clinical symptoms.
