Thirty-year-old Bano Begum was brought to the casualty in a state of altered sensorium. She was on lithium treatment for the affective disorder and suffered an attack of epileptic fits. On examination she has tremors, increased deep tension reflexives, and insentience of urine she also had undergone an episode of severe gastro-enteritis 2 days ago Lithium level in the serum is 1.95 mEq/I. The most