<prompt> A patient is brought to the casualty in the state of altered sensorium. He was on lithium treatment for affective disorder and has suffered through an attack of epileptic fits. On examination he has worsening tremors, increased DTRs and incontinence of urine. He has also undergone an episode of severe gastroenteritis 2 days ago. The probable cause for his present state is:Lithium toxicityDehydrationManic episodeDepressive stupor  <response>: The lithium toxicity may present with tremors, increased reflexes and seizures. Lithium toxicity Dehydration, low sodium diet, renal impairment- precipitates lithium toxicity Narrow therapeutic index1.5 mEqdL GI symptoms- Abdominal pain, vomiting CNS: -Coarse tremors, ataxia, dysahria , Muscle fasciculations, increased DTR, convulsions, impaired consciousness, death Management of lithium Toxicity 1. Stop the drug. 2. Correct dehydration 3. Use of sodium polystyrene sulfonate or polyethylene glycol to remove unabsorbed lithium from GI 4. Hemodialysis in severe cases Acute mania - 1.0- 1.5 mEqdL Maintenance treatment - 0.6 - 1.2 mEqdL Toxicity 1.5 mEqdL 