Continuous Hemodialysis in Severe Lithium Intoxication - A Successful Case Management in a 67-Year-Old Woman

Sep 30, 2026

Uploaded by Kyle

Lithium toxicity is a potentially life-threatening condition marked by neurological, gastrointestinal, and cardiovascular manifestations. While intermittent hemodialysis (IHD) remains standard for severe poisoning, continuous hemodialysis (CHD) or continuous renal replacement therapy (CRRT) may be preferred when hemodynamics are unstable or neurological symptoms are severe. This case describes a 67-year-old woman with severe lithium intoxication successfully treated with CHD. Treatment started before serum lithium results were available, leading to gradual improvement, full recovery, and no symptom recurrence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Introduction

Case Presentation

Table 1: Laboratory Findings on Arrival

Review began 11/19/2025 Review ended 12/04/2025 Published 12/08/2025 © Copyright 2025 Kuwahara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98769 Open Access Case Report Continuous Hemodialysis in Severe Lithium Intoxication: A Successful Case Management in a 67-Year-Old Woman Masaatsu Kuwahara 1, Hideaki Imanaka 1 1. Department of Emergency Medicine and Critical Care, Takarazuka City Hospital, Takarazuka, JPN Corresponding author: Masaatsu Kuwahara, [kuwaharamasaatsu@gmail.com](kuwaharamasaatsu@gmail.com) Abstract Lithium toxicity is a potentially life-threatening condition characterized by neurological, gastrointestinal, and cardiovascular manifestations. Although intermittent hemodialysis (IHD) is the standard of care for severe lithium poisoning, continuous hemodialysis (CHD) or continuous renal replacement therapy (CRRT) may be preferred in cases ofhemodynamic instability or severe neurological symptoms. We report a case of severe lithium intoxication in a 67-year-old woman successfully treated with CHD. Treatment was initiated before the serum lithium concentration became available. Despite marked neurological symptoms, including altered consciousness and tremors, CHD achieved gradual clinical improvement and full recovery without symptom recurrence. Categories: Emergency Medicine Keywords: continuous hemodialysis (chd), elderly patient, lithium intoxication, neurotoxicity, renal replacement therapy Introduction Lithium toxicity was first described in 1898, and its clinical significance became more widely recognized in 1949 when lithium chloride was used as a sodium substitute in patients with heart failure [1] . After the introduction of routine serum monitoring in the 1970s, lithium carbonate received approval in the United States as a therapeutic agent for acute mania and bipolar disorder. Currently, approximately 6,000 to 7,000 cases of lithium intoxication are reported annually to US poison control centers [2] . Lithium carbonate remains a mainstay in the treatment of bipolar and mood disorders, but its narrow therapeutic index (0 .6-1.2 mmol/L) increases the risk of toxicity due to overdose, renal impairment, or dehydration [3] . Severe lithium poisoning (serum lithium > 3 .0 mmol/L) can lead to encephalopathy, tremors, seizures, and cardiac arrhythmias [4] . Although intermittent hemodialysis (IHD) is the standard treatment for lithium intoxication, continuous hemodialysis (CHD) or continuous renal replacement therapy (CRRT) may be preferable in patients with hemodynamic instability, aspiration risk, or severe neurological impairment [5] . We present a case of severe lithium intoxication in an elderly woman successfully managed with CHD, with treatment initiated before the serum lithium concentration became available, resulting in full neurological recovery. Case Presentation A 67-year-old woman with a medical history of type 2 diabetes, hypertension, and depression was brought to the emergency department after experiencing tremors, slurred speech, and recurrent vomiting for two days. Her home medications included lithium carbonate 300 mg/d, lamotrigine 100 mg/d, aripiprazole 3 mg/d, duloxetine hydrochloride 30 mg/d, flunitrazepam 1 mg/d, doxazosin mesylate 1 mg/d, nifedipine 20 mg/d, carvedilol 2 .5 mg/d, tirzepatide 5 mg subcutaneously once weekly, telmisartan 80 mg/d, and trichlormethiazide 2 mg/d. Upon arrival (day 0), she appeared drowsy with a Glasgow Coma Scale (GCS) score of 1-1-4 and was repeatedly vomiting [6] . Her blood pressure was 190/73 mmHg, and oxygen saturation was 95% while receiving high-flow nasal cannula (HFNC) oxygen at 40% FiO₂ and 40 L/min flow. Her temperature was 36.2°C, and the respiratory rate was 30 breaths/min, indicat

FAQs

Why is continuous hemodialysis (CHD) considered in severe lithium poisoning?

The document states that although intermittent hemodialysis (IHD) is standard, CHD or CRRT may be preferable when there is hemodynamic instability or severe neurological symptoms.

When was treatment initiated in the reported case?

Treatment was initiated before the serum lithium concentration became available.

What was the outcome after CHD in this patient?

Despite marked neurological symptoms such as altered consciousness and tremors, CHD led to gradual clinical improvement and full recovery without symptom recurrence.

Sep 30, 2026

Uploaded by Kyle