A case of severe lithium carbonate self-poisoning is described, presenting with sustained vasodilatory shock, DIC and neurologic manifestations. Lengthy and repeated haemodialysis was required to lower lithemia to non-toxic levels in accordance with which the haemodynamic instability and multi organ dysfunction ceased. The patient survived with marked loss of hearing, tinnitus and vertigo as the only sequelae. We discuss the mechanism of lithium's inhibitory effect on the phosphoinositide cascade as the possible explanation for the vasodilatory shock as well as the hearing deficiency.