Medical Emergencies · patient case question
Lithium toxicity in a patient on long-term therapy most characteristically produces:
Patient case: Medical Emergency in the Operatory
demo: 34-year-old female
chief: Composite restoration on tooth #3 under rubber dam isolation.
history: Asthma, well controlled. No known drug allergies. Latex sensitivity not previously documented.
meds: Albuterol inhaler as needed
findings: Ten minutes after rubber dam placement the patient develops audible wheezing, swelling of the lips and periorbital tissue, and urticaria over the neck.
Show answer and explanation
Correct answer: B. Renal impairment, including nephrogenic diabetes insipidus and chronic kidney injury
- A. Hepatic cirrhosis is not a lithium effect; lithium undergoes no hepatic metabolism.
- B. Correct. Lithium is cleared entirely by the kidney and is nephrotoxic; chronic use causes nephrogenic diabetes insipidus and progressive renal impairment, alongside tremor and thyroid effects. NSAIDs raise lithium levels, which matters for dental analgesia.
- C. Pulmonary fibrosis is associated with amiodarone, bleomycin, and methotrexate.
- D. Aplastic anemia is associated with chloramphenicol and carbamazepine, not lithium — lithium actually raises the white count.
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