Question:
A female patient on lithium for bipolar disorder for 6 months fasted for several days for religious reasons and later presented with seizures, tremors, confusion and weakness. Which investigation should be done to diagnose her condition?
A female patient on lithium for bipolar disorder for 6 months fasted for several days for religious reasons and later presented with seizures, tremors, confusion and weakness. Which investigation should be done to diagnose her condition?
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Dehydration plus a narrow-index drug: measure the drug itself.
Updated On: Jun 23, 2026
- Serum electrolytes
- Serum lithium
- ECG
- MRI
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The Correct Option is B
Solution and Explanation
Step 1: Lithium has a narrow therapeutic index and is handled like sodium by the kidney. Fasting with reduced fluid and salt intake causes dehydration and increased renal lithium reabsorption, pushing levels into the toxic range.
Step 2: Tremor, confusion, weakness and seizures in a patient on lithium are classic features of lithium toxicity.
Step 3: To confirm the cause, the most specific and diagnostic test is a serum lithium level. Electrolytes and ECG are useful supportive tests, and MRI is not diagnostic here.
Conclusion: Serum lithium level confirms lithium toxicity.
Ref: Current Diagnosis and Treatment: Psychiatry.
Step 2: Tremor, confusion, weakness and seizures in a patient on lithium are classic features of lithium toxicity.
Step 3: To confirm the cause, the most specific and diagnostic test is a serum lithium level. Electrolytes and ECG are useful supportive tests, and MRI is not diagnostic here.
Conclusion: Serum lithium level confirms lithium toxicity.
Ref: Current Diagnosis and Treatment: Psychiatry.
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