The ‘SILENT Alarm’: When History Taking Reveals a Potentially Fatal Toxicity

Authors

• Sapir Anani Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
• Gal Goldhaber Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
• Yishay Wasserstrum Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
• Amir Dagan Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
• Gad Segal St. Georges School of Medicine, London, program by the University of Nicosia in the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

sapiran87@gmail.com

Keywords

Abstract

Introduction: The combination of acute/sub-acute neurological and metabolic derangements should always raise the suspicion of toxicity, either endogenous or exogenous. The adverse effects of psychiatric medications are especially difficult to determine since the psychiatric background of patients is often inaccessible.

Clinical Presentation: A 66-year-old man presented to the emergency department with dysarthria and uncontrolled tremor, rapidly deteriorating into a complex of severe neurological and metabolic derangements. Only after repeated attempts to take a thorough history was lithium toxicity identified.

Conclusion: Thorough, comprehensive history taking, including chronic medications and their substitutes, is essential and lifesaving when potentially lethal medications are involved.