New onset encephalopathy can have various causes like stroke, trauma, seizures, infections, demyelination, neoplasms, autoimmune, degenerative, and toxic and metabolic etiologies. Triphasic waves in electroencephalogram (EEG) is usually a clue to an ongoing metabolic process. We report a case of a 69-year-old female with bipolar disorder who presented with altered sensorium for the last 2 days. Her metabolic parameters, imaging, and cerebrospinal fluid findings were normal. Her EEG findings in the clinical setting provided a diagnostic clue to lithium toxicity, even though her serum lithium levels were normal. As her sensorium was progressively worsening, she was given a trial of hemodialysis with which she had significant improvement.

Article published online:
26 February 2024

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