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George D. Wilbanks, MD
Chicago

JAMA. 1970;214(7):1325-1326.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The authors wish to thank Drs. Weinstein and Goldfield for their critical review, stressing the intent of the original article which was to caution the use of lithium carbonate during pregnancy, especially in combination with other medications. Diuretics and low sodium diet are known to predispose patients with renal impairment to lithium toxicity and, to a lesser extent, patients with normal renal function.¹ The effects of psychoactive drugs and trihexyphenidyl hydrochloride (Artane) on lithium metabolism, especially during pregnancy and parturition, are not known. Acute manic episodes have been shown to increase the retention of lithium salts in comparison to quiescent periods of the disease.² The interactions of all these factors may have contributed to the toxicity occurring in our patient.

In reply to the specific questions of Drs. Weinstein and Goldfield, the amount of lithium carbonate the patient received was taken from the nursing notes . . . [Full Text PDF of this Article]

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