Acute lithium intoxication: properly directing an index of suspicion.

Lithium is known for its efficacy and toxicity. Toxic effects have been characterized even with therapeutic levels. Most physicians will at some point be faced with a patient with altered mental status and no records of his or her history. The differential diagnosis of altered mental status is long, and further lengthens in a patient with a psychiatric history. Since several life-threatening complications of psychotropic medications exist, physicians must be astute with their diagnoses. Lithium toxicity, neuroleptic malignant syndrome, and the serotonin syndrome can present similarly and require rapid recognition. We present a case of lithium toxicity in a patient who presented with altered mental status and a paucity of history information.