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ACUTE LITHIUM TOXICITY—CHOREA, HYPERCALCEMIA AND HYPERAMYLASEMIA
Author(s) -
MATSIS P. P.,
FISHER R. A.,
TASMANJONES C.
Publication year - 1989
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1989.tb00344.x
Subject(s) - medicine , lithium (medication) , lithium carbonate , chorea , hyperamylasemia , gastroenterology , choreiform movement , hypercalcaemia , endocrinology , surgery , calcium , dyskinesia , amylase , ion , biochemistry , chemistry , physics , disease , quantum mechanics , parkinson's disease , ionic bonding , enzyme
Lithium is widely used in the management of patients with manic depressive illnesses. It is a valuable drug with a good safety record but occasionally causes severe disorders. A 71‐year‐old woman is described who previously had a good response to lithium carbonate treatment of a manic depressive illness. Because the patient appeared depressed and withdrawn, lithium carbonate dosage was increased. The development of confusion and choreiform movements precipitated hospital admission. The symptoms were relieved when lithium was stopped but recurred with the reinstitution of lithium. Spontaneous choreiform movements were again relieved on lithium withdrawal. Associated with the abnormal movements were alterations in the serum calcium concentrations, a rise in the parathyroid hormone concentration and a rise in the serum amylase concentration without features of acute pancreatitis. SUMMARY This patient presents uncommon complications of therapy with lithium carbonate. Hypercalcemia is a well reported complication of lithium therapy and the associated raised parathyroid hormone may be due to modification of the threshold of parathyroid tissue to calcium under the influence of lithium. Chorea in lithium toxicity is uncommon and is not yet fully explained. Hyperamylasemia has not been previously reported. We suggest that in patients having long‐term lithium therapy that periodic checks of the serum calcium, parathyroid hormone and amylase levels should be undertaken.