Lithium Toxicity and ACE Inhibitor Interaction
A branching clinical case simulation for a patient presenting with tremor, ataxia, confusion and vomiting. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 45 years, female
- Presenting complaint
- Tremor, ataxia, confusion and vomiting
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
Mrs Susan Miller is a 45-year-old woman with a history of bipolar disorder, on long-term lithium. She presents with a 3-day history of vomiting, confusion, and worsening tremor. Her husband says she has been more unsteady on her feet and cannot keep any fluids down. He mentions that two weeks ago she was started on a new blood pressure tablet. She is currently in the ED, drowsy and vomiting. You are the resident on duty.
What this case teaches
Recognise lithium toxicity and its precipitants; measure the level and renal function; rehydrate; know the indications for haemodialysis; stop the interacting drug.
How the case unfolds
- 1Focused history takingHistory
- 2Focused examinationExamination
- 3Initial investigationsInvestigations
- 4Interpreting the resultsDiagnosis
- 5Initial managementTreatment
- 6Reassessment and dialysis decisionMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
Log in to run "Lithium Toxicity and ACE Inhibitor Interaction"
A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.