Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome
Lithium, despite being an indispensable agent in the treatment of psychiatric disorders, has a narrow therapeutic index and needs to be carefully administered. Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication due to central dopaminergic blockade. This case report ill...
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China Medical University
2024
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my.upm.eprints.1146262025-01-21T04:41:39Z http://psasir.upm.edu.my/id/eprint/114626/ Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome Lai, Yin Ye Mohamed Mokhtar, Normaizuwana Samsudin, Intan Nureslyna Thambiah, Subashini C. Lithium, despite being an indispensable agent in the treatment of psychiatric disorders, has a narrow therapeutic index and needs to be carefully administered. Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication due to central dopaminergic blockade. This case report illustrates the challenges in lithium therapy particularly related to the development of NMS when further risk factors such as polypharmacy and dehydration are present. We report a case of a 50-year-old man with underlying bipolar affective disorder who was previously able to tolerate olanzapine and lithium well, however developed chronic lithium toxicity due to diminished lithium elimination in acute kidney injury following a two-week history of viral acute gastroenteritis. He also developed NMS which could either be triggered independently by olanzapine; lithium toxicity; or attributed by a synergistic combination from lithium and olanzapine which led to an enhanced neurotoxicity in an already unstable dopaminergic pathway. Fluid therapy and supportive care allowed the patient to recover, and he was discharged well with a lower potency neuroleptic with slow dose titration. China Medical University 2024-09-01 Article PeerReviewed text en cc_by_4 http://psasir.upm.edu.my/id/eprint/114626/1/114626.pdf Lai, Yin Ye and Mohamed Mokhtar, Normaizuwana and Samsudin, Intan Nureslyna and Thambiah, Subashini C. (2024) Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome. BioMedicine (Taiwan), 14 (3). art. no. 6. pp. 49-52. ISSN 2211-8020; eISSN: 2211-8039 https://www.biomedicinej.com/biomedicine/vol14/iss3/6/ 10.37796/2211-8039.1459 |
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Lithium, despite being an indispensable agent in the treatment of psychiatric disorders, has a narrow therapeutic index and needs to be carefully administered. Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication due to central dopaminergic blockade. This case report illustrates the challenges in lithium therapy particularly related to the development of NMS when further risk factors such as polypharmacy and dehydration are present. We report a case of a 50-year-old man with underlying bipolar affective disorder who was previously able to tolerate olanzapine and lithium well, however developed chronic lithium toxicity due to diminished lithium elimination in acute kidney injury following a two-week history of viral acute gastroenteritis. He also developed NMS which could either be triggered independently by olanzapine; lithium toxicity; or attributed by a synergistic combination from lithium and olanzapine which led to an enhanced neurotoxicity in an already unstable dopaminergic pathway. Fluid therapy and supportive care allowed the patient to recover, and he was discharged well with a lower potency neuroleptic with slow dose titration. |
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Lai, Yin Ye Mohamed Mokhtar, Normaizuwana Samsudin, Intan Nureslyna Thambiah, Subashini C. |
spellingShingle |
Lai, Yin Ye Mohamed Mokhtar, Normaizuwana Samsudin, Intan Nureslyna Thambiah, Subashini C. Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
author_facet |
Lai, Yin Ye Mohamed Mokhtar, Normaizuwana Samsudin, Intan Nureslyna Thambiah, Subashini C. |
author_sort |
Lai, Yin Ye |
title |
Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
title_short |
Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
title_full |
Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
title_fullStr |
Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
title_full_unstemmed |
Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
title_sort |
acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome |
publisher |
China Medical University |
publishDate |
2024 |
url |
http://psasir.upm.edu.my/id/eprint/114626/1/114626.pdf http://psasir.upm.edu.my/id/eprint/114626/ https://www.biomedicinej.com/biomedicine/vol14/iss3/6/ |
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