Case 4 – Feeling Fatigued

Case #4: Feeling Fatigued
Author: Michael Gottlieb, MD
Peer Reviewer: Jenny Lu, MD

A 26 year old male with a past medical history of Bipolar Disorder is brought to the ED by family members after they noted he has had decreased memory and concentration over the past week. On further prompting, he also notes that he has felt increasingly fatigued and has not been eating or drinking much over the past two weeks. He is currently on medication for his Bipolar Disorder, but denies any additional medications (including herbal and over-the-counter medications), as well as any recent changes in his medication. The exam is significant only for a mild resting tremor of both hands.

Vitals: Temp: 98.0, HR: 62, BP: 110/72, RR: 8, O2 Sat: 98% on RA

What is the most likely etiology of this patient’s presentation?
What other clinical symptoms might you expect to see with this patient?
What is the initial treatment for this patient?
Is this medication dialyzable?
What laboratory error can cause a falsely elevated level of this medication?
What is the disposition for these patients?


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Wills BK, Mycyk MB, Mazor S, et al. Factitious lithium toxicity secondary to lithium heparin-containing blood tubes. J Med Toxicol. 2006 Jun;2(2):61-3.

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