Ibuprofen/lithium interaction: Lithium toxicity: case report

Ibuprofen/lithium interaction Lithium toxicity: case report

A 51-year-old man developed lithium toxicity during concomitant use of lithium and ibuprofen.

The man, who had a history of schizophrenia and bipolar disorder, was receiving chronic treatment with lithium [dosage and route not stated]. He presented to an emergency department with progressively worsening mental status, that had been preceded by abnormal gait, dysarthria and diarrhoea [duration of treatment to reaction onset not stated]. Before presentation, he had poor oral intake and had been receiving ibuprofen for pain control in the context of a recent dental procedure [dosage, route and duration of treatment to reaction onset not stated]. Tests found elevated lithium levels and mild renal failure.

The man received hydration and supportive care, and his lithium levels and renal function improved. However, his mental status did not improve after normalisation of his lithium levels, and EEG showed metabolic encephalopathy. He was intubated and received further supportive care. Within a few days, his mental status returned to baseline and he was extubated.

Author comment: "There is evidence that non steroidal anti inflammatory medications (NSAID) can increase lithium levels and decrease renal clearance. We present a case of lithium toxicity which demonstrates this effect".