Lithium toxicity from an internet dietary supplement
- 439 Downloads
The widespread availability of medications and herbal products on the Internet has increased the potential for poisonings. We are reporting a case of mild, acute lithium toxicity occurring after the intentional misuse of a lithium-containing “dietary supplement” (Find Serenity Now®) obtained over the Internet.
An 18-year-old woman presented to our emergency department (ED) after ingesting 18 tablets of Find Serenity Now®; each tablet contained, according to the listing, 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic) lithium carbonate]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. Almost 90 minutes after the ingestion, her serum lithium level was 0.31 mEq/L, a urine drug screen was negative, and an electrocardiogram (ECG) showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic; one hour later, her repeat serum lithium level was 0.40 mEq/L. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Prior human and animal data have shown similar pharmacokinetics and shared clinical effects of these lithium salts.
Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.
KeywordsInternet lithium toxicity
- 3.Find Serenity Now Home Page. Urban Nutrition, LLC. Accessed January 30,2007. http://www.findserenitynow.com.Google Scholar
- 5.Smith DF, Schou M. Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate.J Pharm Pharmacol. 1979; 31(3): 61–63.Google Scholar
- 11.Groleau G. Lithium toxicity.Emerg Med Clinics of North America.1994; 12(2): 511–528.Google Scholar