Hypertensive bipolar: chronic lithium toxicity in patients taking ACE inhibitor

Abstract

A patient with bipolar I disorder has been treated with lithium and haloperidol for the last 20 years and received an ACE inhibitor for his hypertension since 9 years ago. Despite regular clinic follow-ups and blood monitoring, he recently developed tremors and delirium. On hospital admission, serum level of lithium was far above toxic level. Mental state examination revealed an anxious and disorientated man with irrelevant speech. Immediate discontinuation of lithium resulted in slow reduction of serum lithium levels and gradual resolution of tremor but his delirium persisted for 2 weeks. His condition took a turn for the worse when he developed acute renal failure and arm abscess. We discussed about lithium toxicity and the vulnerability factors which have induced delirium and renal failure in this patient.

Unmet challenges in treating hypertension in patients with borderline personality disorder

“…[31,76] Concomitant use of these pharmacological agents may increase the serum concentration level of lithium to a toxic level and cause life-threatening neurologic and cardiac symptoms including lethargy and arrhythmias. [77]…”

Psychiatric and Behavioral Disorders

“…The symptoms have disrupted your social life/leisure activities: tion of lithium through the kidneys, increasing toxicity risk as well as renal failure especially in individuals with long-term lithium use [39]. Due to lithium's effects on renal excretion and resultant hemodynamic changes, discontinuing lithium preoperatively is recommended approximately 3 days prior to surgery with no concern for withdrawal symptoms [40].…”

Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness

“…Carbamazepine has been associated with acute onset of hypertension in several case reports ( 83 – 85 ). It should be noted that concomitant use of angiotensin-converting enzyme (ACE)-inhibitors or angiotensin II receptor blockers (ARBs) with lithium can lead to acute or chronic lithium toxicity ( 86 , 87 ).…”