The ‘SILENT Alarm’: When History Taking Reveals a Potentially Fatal Toxicity

  • Sapir Anani Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
  • Gal Goldhaber Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
  • Yishay Wasserstrum Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
  • Amir Dagan Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
  • Gad Segal St. Georges School of Medicine, London, program by the University of Nicosia in the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

Keywords

Lithium, SILENT syndrome, history taking, bipolar disorder, drug toxicity

Abstract

Introduction: The combination of acute/sub-acute neurological and metabolic derangements should always raise the suspicion of toxicity, either endogenous or exogenous. The adverse effects of psychiatric medications are especially difficult to determine since the psychiatric background of patients is often inaccessible.

Clinical Presentation: A 66-year-old man presented to the emergency department with dysarthria and uncontrolled tremor, rapidly deteriorating into a complex of severe neurological and metabolic derangements. Only after repeated attempts to take a thorough history was lithium toxicity identified.

Conclusion: Thorough, comprehensive history taking, including chronic medications and their substitutes, is essential and lifesaving when potentially lethal medications are involved.

References

  • Baird-Gunning J, Hons B, Lea-Henry T, Hoegberg LCG, Gosselin S, Em F, et al. Lithium poisoning. J Intens Care Med 2016;32:249–263.

  • Hillert M, Zimmermann M, Klein J. Uptake of lithium into rat brain after acute and chronic administration. Neurosci Lett 2012;521:62–6.

  • Ehrlich BE, Diamond JM. Lithium, membranes, and manic-depressive illness. J Membr Biol 1980;52:187–200.

  • Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry 2001;35:833–840.
  • Published: 2018-03-22

    Issue: Vol 5 No 6 (view)

    Section: Articles

    How to cite:
    Anani, S., Goldhaber, G., Wasserstrum, Y., Dagan, A., & Segal, G. (2018). The ‘SILENT Alarm’: When History Taking Reveals a Potentially Fatal Toxicity. European Journal of Case Reports in Internal Medicine, 5(6). https://doi.org/https://doi.org/10.12890/2018_000843