Content area
Full Text
After self-discontinuing lithium, a 49-year-old woman with bipolar disorder developed severe mania complicated by delirium, hypercalcaemia, hyperparathyroidism and nephrogenic diabetes insipidus.
On presentation, the woman exhibited an elated mood, irritability and hypertalkativeness and was experiencing visual hallucinations; she was alert and oriented. Her medical history was notable for bipolar disorder of 20 years' duration and her medications included lithium 600 mg/day and propranolol. Her family reported that she had discontinued lithium 3 weeks earlier and that her altered mental status and hallucinations had started around 7 and 2 days prior to presentation, respectively. Neither polydypsia nor polyuria were evident prior to presentation. On examination, her BP...