Lithium toxicity and the parturient: case report and literature review

Abstract A 39-year-old gravida 8, para 6 woman at 34 weeks of a twin gestation was admitted to the antenatal ward with severe agitation and restlessness. She had a history of unstable bipolar disorder for which she was treated with lithium. Before admission she had been under close supervision by ps...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2008-04, Vol.17 (2), p.164-169
Main Authors: Blake, L.D, Lucas, D.N, Aziz, K, Castello-Cortes, A, Robinson, P.N
Format: Article
Language:English
Subjects:
Adult
Anesthesia & Perioperative Care
Anesthesia, General - adverse effects
Anesthesia, General - methods
Bipolar Disorder - complications
Bipolar Disorder - drug therapy
Caesarean section
Cesarean Section
Female
General Anaesthesia
Glasgow Coma Scale
Humans
Infant, Newborn
Infant, Premature, Diseases - chemically induced
Lithium
Lithium Compounds - adverse effects
Male
Obstetrics and Gynecology
Pregnancy
Pregnancy Complications - drug therapy
Pregnancy Complications - psychology
Prenatal Exposure Delayed Effects
Treatment Outcome
Twins
Urinoma - complications
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Summary:Abstract A 39-year-old gravida 8, para 6 woman at 34 weeks of a twin gestation was admitted to the antenatal ward with severe agitation and restlessness. She had a history of unstable bipolar disorder for which she was treated with lithium. Before admission she had been under close supervision by psychiatric and obstetric teams and lithium levels had been stable. However, an acute deterioration in renal function secondary to ureteric obstruction resulted in toxic plasma lithium levels and associated clinical features. An emergency caesarean section was carried out under general anaesthesia. We provide a review of the current literature including: the pharmacology of lithium, the effects of lithium on fetus and mother, and the current guidelines for management of lithium treatment during pregnancy. Lithium is prescribed relatively rarely during pregnancy. We aim to increase awareness about the issues involved in the management of women receiving lithium during pregnancy.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2007.09.014