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Contributor: Peter Bakes, MD
Educational Pearls:
- Lithium remains a commonly used medication for treating bipolar disorder
- Lithium toxicity can be acute, acute-on-chronic, or chronic
- Measuring blood lithium level
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- Therapeutic range of lithium is around 1.6-1.8 mEq/L
- >2 mEq/L is likely to cause significant toxicity
- >4 mEq/L necessitates lifesaving treatment
- The lethal dose of lithium is 700 mg/kg
- Lithium can have delayed absorption resulting in levels increasing during hospitalization
- Symptoms associated with acute lithium toxicity
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- Gastrointestinal
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- Nausea, vomiting, abdominal pain
- Neurological
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- Tremor, nystagmus, CNS depression (late finding)
- Cardiovascular
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- Bradycardia, QT prolongation, EKG changes
- Treatment for lithium toxicity
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- ABCs
- Get a good history
- GI Decontamination:
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- Whole bowel irrigation if patient ingested extended-release tablets
- Dialysis
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- Most effective treatment for lithium toxicity
References
Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium Poisoning. J Intensive Care Med. 2017;32(4):249-263.
Hedya SA, Avula A, Swoboda HD. Lithium Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.
McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728.
