Letter to the Editor

Lithium Toxicity or Laboratory Error?

Authors: [Michael E. Mullins, MD

Abstract

To the Editor:


In the case report of possible lithium toxicity by Thompson and Johnson,1 the symptoms are better explained by serotonin syndrome or mild neuroleptic malignant syndrome associated with an atypical antipsychotic. Hyperthermia, which the authors use to exclude these two diagnoses, is not a sine qua non. Serotonin syndrome and neuroleptic malignant syndrome can and do occur with normal temperature.

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References

1. Thompson JW, Johnson AC. Acute lithium intoxication: properly directing an index of suspicion. South Med J 2011;104:371-372.
 
2. Lee DC, Klachko MN. Falsely elevated lithium levels in plasma samples obtained in lithium containing tubes. J Toxicol Clin Toxicol 1996;34:467-469.
 
3. Nordt SP, Cantrell FL. Elevated lithium level: a case and brief overview of lithium poisoning. Psychosom Med 1999;61:564-565.
 
4. Malzbacher A, Engler H, Drack G, et al. Lethargy in a newborn: lithium toxicity or lab error? J Perinat Med 2003;340-342.
 
5. Wills BK, Mycyk MB, Mazor S, et al. Factitious lithium toxicity secondary to lithium heparin-containing blood tubes. J Med Toxicol 2006;2:61-63.