I am going with a chronic, moderate to severe lithium overdose. Patient is taking numerous medications that cause increased Li concentrations. HCTZ, Ibuprofen, Indocin, gabapentin, and even some OTC herbals all increase serum LI concentrations.
The HCTZ is one of the main culprits seen in interaction overdoses when used by itself. Combining HCTZ with the ingestion of three other KNOWN causes of increased Li levels has to make you consider Li toxicity in your differential diganosis. That is before you even factor in the unknown "herbal" meds that also can increase serum Li levels...
Also, most if not all pertinant findings in history and physical can be onserved in Li toxicity.
