Journal of Medical Toxicology

, Volume 3, Issue 2, pp 61–62 | Cite as

Lithium toxicity from an internet dietary supplement

  • D. K. PauzéEmail author
  • D. E. Brooks
Toxicology Observations



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.

Case Report

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.


Internet lithium toxicity 


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Copyright information

© American College of Medical Toxicology 2007

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Pittsburgh Medical CenterPittsburgh
  2. 2.Division of Medical ToxicologyUniversity of Pittsburgh Medical CenterPittsburgh

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