Medical Solicitors director, Matthew Brown, has recovered £15,000 compensation for the estate of a woman who suffered lithium toxicity.
The woman, who was in her 80s at the time of the incident, suffered three falls, neurological dysfunction, hair loss, and a general decline in health after her GP practice continued to prescribe lithium despite the absence of the results of blood testing to monitor her lithium blood levels. This gradually led to an overdose.
She sadly passed away before the settlement was reached. But her daughter, who was her litigation friend, was supported to make a medical negligence claim on behalf of her elderly mother.
Case summary
The claimant ‘C’ had a history of bipolar depression and was prescribed lithium to stabilise her mood.
Patients taking lithium need to keep the amount in their blood at the right level as too much can make them very ill. This should be monitored via regular blood tests.
C’s GP practice was notified by Leicestershire Lithium Register that C was due her next serum lithium blood test on 5th June 2017. However, this did not take place.
Ten days after the blood test had been due, C began to feel unwell. She was vomiting, had diarrhoea, abdominal pain, was shaking and had instability in her legs. All of these symptoms can be signs of lithium overdose. However, while a blood test was taken during a home visit by C’s GP, lithium levels were not requested. She was given her monthly repeat prescription as normal.
Her condition worsened over the next two weeks and C’s daughter contacted the GP practice who made another home visit. She was given medication for the diarrhoea and abdominal pain but again, no blood test to check her lithium levels was taken. Her monthly prescription was again issued as normal.
On 19th July, C was admitted to hospital with a suspected pulmonary embolism. This was ruled out and she was discharged. She then fell at home which led to her daughter requesting a social care assessment.
After another hospital admission, C was discharged to a residential care home which meant that her care was transferred to another GP practice that covered the care home.
C fell while in the care home on 13th August and injured her coccyx. A GP from the new practice visited and took a blood test. They returned two days later when C was noted to be drowsy, confused, slurring and having muscle spasms. A potential diagnosis of lower respiratory tract infection with lithium toxicity was made and C was taken to hospital via ambulance.
Her serum lithium level was high at 2.53: toxicity occurs at levels above 1.5. Her kidney function had also deteriorated.
Administration of lithium was stopped and C’s lithium level dropped significantly over the following days. Lithium was then reinstated at half of the previous dose. By the end of the year, she was mobilising and her mood was stable. She was able to return to living alone semi-independently but suffered significant hair loss and associated distress as a result of the toxicity.
Litigation
C’s daughter, acting as a litigation friend, sought the help of Medical Solicitors to bring a medical negligence claim against the GP practice. The family had already submitted an official complaint, and the GP practice apologised for failing to test C’s lithium levels.
However, they asserted that other medical problems C had were more likely to have caused her symptoms. They also denied that it was the GP’s responsibility to note that a blood test was due or to check that a blood test was not overdue before issuing a repeat prescription.
Matthew Brown, the family’s representative, challenged this by highlighting that NHS guidelines clearly state that General Practitioners should ‘satisfy themselves that appropriate monitoring is being conducted and that it is safe to issue a repeat prescription before they do so’.
C sadly passed away from an unrelated illness in December 2021 before any settlement was reached. The GP practice made an initial offer of £10,000 which was then increased to £15,000 and accepted by C’s daughter in April 2023. This included roughly £12,000 general damages and special damages of around £3,000 for additional care, equipment, travel and care home fees.