Lithium toxicity at therapeutic doses as a fallout of COVID-19 infection: a case series and possible mechanisms.
Anti-Inflammatory Agents, Non-Steroidal
/ adverse effects
Antimanic Agents
/ adverse effects
Bipolar Disorder
/ complications
COVID-19
/ complications
Creatinine
/ blood
Fatal Outcome
Humans
Hyperkalemia
/ chemically induced
Hypernatremia
/ chemically induced
Lithium Compounds
/ adverse effects
Male
Middle Aged
Respiratory Insufficiency
/ chemically induced
Tachycardia, Ventricular
/ chemically induced
Urea
/ blood
Journal
International clinical psychopharmacology
ISSN: 1473-5857
Titre abrégé: Int Clin Psychopharmacol
Pays: England
ID NLM: 8609061
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
24
10
2021
medline:
15
12
2021
entrez:
23
10
2021
Statut:
ppublish
Résumé
Lithium, a mood stabilizer used in the treatment of bipolar disorder is known for its anti-inflammatory properties with the discussion of its potential use in COVID-19 infection. The SARS-CoV-2 virus causing COVID-19 infection is known to enter the target cells through angiotensin converting enzyme-2 receptors present in abundance in the lung and renal tissue. Recent research supports the evidence for direct renal injury by viral proteins. Here we report two patients with bipolar disorder presenting with lithium toxicity in the presence of COVID-19 infection. Two patients with bipolar disorder, maintaining remission on lithium prophylaxis, presented to the psychiatric emergency with recent-onset fever and altered sensorium. Both the patient's investigations revealed lithium toxicity, elevated serum creatinine, urea and inflammatory markers. Hypernatremia, hyperkalaemia, and hyperchloremia were seen in one patient. Lithium and other psychotropic medications were stopped immediately, and COVID-19 treatment was initiated. Patient with clinical signs of lithium toxicity, hypernatremia, hyperkalaemia, and hyperchloremia developed ventricular tachycardia. He survived and regained consciousness after 2 weeks of aggressive conservative management. However, another patient died of acute respiratory failure on day 3. Possible direct infection of the kidney by SARS-CoV-2 viral proteins can manifest with acute kidney injury and lithium toxicity among patients on long-term lithium therapy. Health professionals treating COVID-19 infection among individuals on lithium therapy should be aware of the possibility of lithium toxicity in the background of renal injury.
Identifiants
pubmed: 34686643
doi: 10.1097/YIC.0000000000000379
pii: 00004850-202201000-00005
pmc: PMC8635074
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Antimanic Agents
0
Lithium Compounds
0
Urea
8W8T17847W
Creatinine
AYI8EX34EU
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
25-28Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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