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Suddenly, a man discovered that numerous edibles began to taste repulsive to him.(Image credit: Michael H via Getty Images)
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The patient: A 61-year-old gentleman in Japan
The symptoms: The gentleman presented to a medical facility due to experiencing an extremely unpleasant taste from certain foods and beverages approximately two months prior. Over time, an increasing number of foods became difficult for him to consume. Initially, sour and salty tastes provoked revulsion. This was followed by oily foods, then fresh produce, chilled water and juices, warm water, and finally, sweet items.
The man reduced his food intake owing to the taste aversions, resulting in an unintentional weight loss of a few pounds. He conveyed to the hospital physicians that he felt fatigued, as documented in a medical report of the case.
What happened next: The patient, who was a medical practitioner himself, disclosed that eight years prior, he had been diagnosed with bipolar disorder. For the preceding three years, he had been managing this condition with lithium, a medication commonly employed as a mood stabilizer for bipolar disorder.
He was administered a prescribed dosage of 800 milligrams daily and had not experienced any unusual adverse reactions historically. (This dosage is slightly above the standard recommendation for the continuous management of bipolar disorder; however, physicians may adjust patient dosages based on their specific requirements.)
The diagnosis: Medical practitioners conducted blood tests and discovered that the concentration of lithium in the patient’s bloodstream measured 1.28 milliequivalents per liter (mEq/L). Acceptable lithium levels range between 0.6 and 1.2 mEq/L; exceeding this threshold can lead to a condition known as lithium toxicity, which can be life-threatening if not addressed.
Upon reviewing the man’s medical history, the physicians noted that before the emergence of his symptoms, his blood lithium levels were within the range of 0.4 to 0.9 mEq/L. The authors of the report did not investigate the cause of this toxicity or propose theories regarding the accumulation of lithium in the patient’s system.
The treatment: The physicians advised the man to discontinue his lithium medication and instead prescribed an alternative mood-stabilizing drug called valproate. As the lithium levels in his blood subsided, the patient regained his energy, and the foods and beverages that had previously caused him disgust reverted to their normal flavors. Notably, this recovery occurred in the inverse sequence of how the flavors had initially changed.
At a follow-up consultation one year later, the man was still undergoing treatment with valproate, and his symptoms of fatigue and taste alterations had not recurred.
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What makes the case unique: Although not common, side effects associated with lithium use can encompass confusion, increased thirst, frequent urination, an irregular or slow heart rhythm, weariness, and weight gain. Less frequent adverse effects include lightheadedness, headaches, visual disturbances, and a loss of heat in the extremities. Lithium toxicity, also referred to as lithium intoxication, is recognized to elevate the risk of these negative symptoms.
Alterations in a patient’s sense of taste while undergoing lithium treatment have been documented in a limited number of reports originating from the 1970s and 1980s. One individual lost the capacity to detect salt, while another “observed a peculiar and disagreeable taste in conjunction with butter and celery.”
Nevertheless, “it has not been widely acknowledged that lithium can induce a loss or modification of taste in certain individuals,” as stated by the authors of the case report. Drawing from their findings, they proposed that in the future, a decline or shift in taste perception should be identified as a potential marker for mild lithium intoxication.
