Toxicidade Multissistémica por Lítio: a propósito de um Caso Clínico

Background: Lithium carbonate is used as a first line treatment of bipolar disorder, however given its narrow therapeutic range, it needs regular monitoring of lithium serum levels and occurrence of any symptoms and signs of toxicity. Aims: To illustrate diagnosis complexity and approach to prolonged lithium treatment associated toxicity. Methods: Report of a clinical case and review of the literature. Results: The authors present the case of a 53-year-old woman diagnosed with bipolar disorder that had been medicated with lithium carbonate at a dose of 600 mg / day for 28 years. Nevertheless, this person abandoned clinical follow-up 8 years before, maintaining unmonitored medication. The patient was admitted to the emergency department due to disorientation, incoherent speech, ataxia and tremors. From complementary exams, it can be highlighted the existence of lithium serum levels of 4.07 mmol/L, constituting a medical emergency. Conclusion: Treatment with lithium, without clinical and laboratory monitoring, may lead to severe multisystemic toxicity, and eventually be fatal.