Symptom Overlap of Acute Mountain Sickness and Lithium Toxicity: A Case Report

Abstract

Uber, Amy, and Claire Twark. Symptom overlap of acute mountain sickness and lithium toxicity: a case report. High Alt Med Biol. 23:291-293, 2022.-Mild lithium toxicity and acute mountain sickness share multiple overlapping features. We report a case of a patient with bipolar disorder on lithium who hiked to altitude and experienced symptoms that are shared by both conditions. We review the literature on lithium fluctuations under similar conditions showing that acute altitude exposure may elevate serum lithium levels and excess sweating may lower lithium levels, despite the prevailing thought that fluid loss concentrates serum lithium levels. We advise individualized testing of athletes' lithium levels in response to exercise and altitude, and we recommend physicians counsel their patients on ways to maintain therapeutic lithium levels during their athletic pursuits, including the importance of hydration and avoidance of nonsteroidal anti-inflammatory drugs. Further research is needed on lithium pharmacokinetics in conditions of exercise and altitude exposure.

Keywords: acute mountain sickness; altitude; bipolar disorder; lithium toxicity.