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Central Pontine Myelinolysis and Lithium Toxicity

Central Pontine Myelinolysis and Lithium Toxicity P1: JLS Annals of Clinical Psychiatry (ACLI) pp918-acli-469286 July 8, 2003 10:4 Style file version Nov. 28, 2000 ° C Annals of Clinical Psychiatry, Vol. 15, No. 2, June 2003 ( 2003) Communication Conrad M. Swartz, PhD, MD Fabisiak et al. (1) report a case of central large fall are possible explanations for the observed pontine myelinolysis (CPM) in a patient taking CPM. This suggests a clinical consideration in addi- lithium. CPM was previously mentioned in this jour- tion to those mentioned by Fabisiak et al. Patients nal as a likely consequence of a rapid fall of serum taking lithium for at least most of a week who develop lithium levels after a gradual rise to high levels (2, 3). dehydration, confusion, or increased thirst or tremor Such rapid lithium fall is associated with neurological might need hospitalization and consideration for injury (4). The physiological background is that gradual rather than abrupt correction of high lithium 1) intracellular sodium levels are about 7 meq/L, levels (5). 2) lithium displaces sodium intracellularly, and 3) CNS intracellular lithium levels are 50% above serum levels. Accordingly, a rapid decrease in lithium lev- REFERENCES els might cause intracellular hyponatremia, which would be rapidly http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Clinical Psychiatry Springer Journals

Central Pontine Myelinolysis and Lithium Toxicity

Swartz, Conrad
Annals of Clinical Psychiatry , Volume 15 (2) – Oct 11, 2004
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Central Pontine Myelinolysis and Lithium Toxicity

Abstract

P1: JLS Annals of Clinical Psychiatry (ACLI) pp918-acli-469286 July 8, 2003 10:4 Style file version Nov. 28, 2000 ° C Annals of Clinical Psychiatry, Vol. 15, No. 2, June 2003 ( 2003) Communication Conrad M. Swartz, PhD, MD Fabisiak et al. (1) report a case of central large fall are possible explanations for the observed pontine myelinolysis (CPM) in a patient taking CPM. This suggests a clinical consideration in addi- lithium. CPM was previously mentioned in this jour- tion to those...
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Publisher
Springer Journals
Copyright
Copyright © 2003 by American Academy of Clinical Psychiatrists
Subject
Medicine & Public Health; Neurology; Psychiatry; Psychopharmacology
ISSN
1040-1237
eISSN
1573-3238
DOI
10.1023/A:1024644511002
Publisher site
See Article on Publisher Site

Abstract

P1: JLS Annals of Clinical Psychiatry (ACLI) pp918-acli-469286 July 8, 2003 10:4 Style file version Nov. 28, 2000 ° C Annals of Clinical Psychiatry, Vol. 15, No. 2, June 2003 ( 2003) Communication Conrad M. Swartz, PhD, MD Fabisiak et al. (1) report a case of central large fall are possible explanations for the observed pontine myelinolysis (CPM) in a patient taking CPM. This suggests a clinical consideration in addi- lithium. CPM was previously mentioned in this jour- tion to those mentioned by Fabisiak et al. Patients nal as a likely consequence of a rapid fall of serum taking lithium for at least most of a week who develop lithium levels after a gradual rise to high levels (2, 3). dehydration, confusion, or increased thirst or tremor Such rapid lithium fall is associated with neurological might need hospitalization and consideration for injury (4). The physiological background is that gradual rather than abrupt correction of high lithium 1) intracellular sodium levels are about 7 meq/L, levels (5). 2) lithium displaces sodium intracellularly, and 3) CNS intracellular lithium levels are 50% above serum levels. Accordingly, a rapid decrease in lithium lev- REFERENCES els might cause intracellular hyponatremia, which would be rapidly

Journal

Annals of Clinical Psychiatry – Springer Journals

Published: Oct 11, 2004

References

  • Central pontine myelinolysis manifested by temporary blindness: A possible complication of lithium toxicity
    Fabisiak, DB; Murray, GB; Stern, TA
  • Encephalopathy associated with rapid decrease of high levels of lithium
    Swartz, CM; Dolinar, LJ
  • Commentary on “Encephalopathy associated with rapid decrease of high levels of lithium.”
    Swartz, CM
  • Hyperlithemia correction and persistent delirium
    Swartz, CM; Jones, P
  • A case for gradual reduction of high lithium levels
    Swartz, CM