| Download the amazing global Makindo app: Android | Apple | |
|---|---|
| MEDICAL DISCLAIMER: Educational use only. Not for diagnosis or management. See below for full disclaimer. |
Lithium toxicity
Related Subjects: |Drug Toxicity - clinical assessment |Metabolic acidosis |Aspirin or Salicylates toxicity |Ethylene glycol toxicity |Ethanol toxicity |Methanol toxicity |Ricin toxicity |Carbon Tetrachloride Toxicity |Renal Tubular Acidosis |Lactic acidosis |Iron Toxicity |Tricyclic Antidepressant Toxicity |Opiate Toxicity |Carbon monoxide Toxicity |Benzodiazepine Toxicity |Paracetamol (Acetaminophen) toxicity |Amphetamine toxicity |Beta Blocker toxicity |Calcium channel blockers toxicity |Cannabis toxicity |Cyanide toxicity |Digoxin Toxicity |Lithium Toxicity |NSAIDS Toxicity |Ecstasy toxicity |Paraquat toxicity |Quinine toxicity |SSRI Toxicity |Theophylline Toxicity |Organophosphate (OP) Toxicity |Toxin elimination by dialysis |Drug Toxicity with Specific Antidotes
⚠️ Always seek cardiology input before stopping antiplatelets after coronary stenting.
⚠️ Haemodialysis is the mainstay of treatment for acute severe lithium toxicity. 💡 Lithium usually causes a fine tremor at therapeutic doses - a coarse tremor suggests toxicity.
📖 About
- Lithium Toxicity ⚡: An alkali metal prescribed for bipolar disorder as a mood stabiliser. Narrow therapeutic window makes toxicity common in both acute overdose and chronic accumulation.
💊 Pharmacology
- Therapeutic range: 0.6–1.2 mmol/L (some guidelines 0.4–1.0).
- Toxicity: Usually >1.5 mmol/L. Severe neurotoxicity at >2.0, coma at >3.0.
- Rapid GI absorption, minimal protein binding → dialysable.
- 🚰 Risk factors: dehydration, renal impairment, diuretics.
🧠 Clinical Presentation
- Acute toxicity: coarse tremor 🤲, dysarthria, confusion, delirium, seizures, coma.
- Polyuria & polydipsia: due to nephrogenic diabetes insipidus.
- Chronic toxicity: insidious encephalopathy, ataxia, neuropathy, cerebellar dysfunction.
⚠️ Exacerbating Interactions
- 💊 Thiazide diuretics
- 💊 NSAIDs
- 💊 ACE inhibitors
- 💊 Loop diuretics (less marked)
- Risk ↑ with age, dehydration, renal disease.
🔬 Investigations
- 📈 Lithium levels: repeat every 4–6h until falling; symptoms often lag behind levels.
- 🫀 ECG: may show T-wave flattening, QT prolongation.
- 🧪 Renal function, U&E, thyroid function, calcium (chronic lithium → hyperparathyroidism).
💊 Management
- 🛑 Stop lithium immediately; withhold interacting drugs.
- 💧 IV normal saline: aggressive rehydration to enhance renal clearance.
- 🚫 GI decontamination: charcoal ineffective. Whole-bowel irrigation if sustained-release prep or very large ingestion.
- 💉 Haemodialysis: gold standard if level >4.0 mmol/L acutely, >2.5 mmol/L with symptoms, or in renal failure. May need repeated sessions due to tissue redistribution.
- Consult TOXBASE / NPIS for specialist advice.
⚠️ Complications
- Persistent cerebellar signs: truncal/gait ataxia, nystagmus, memory loss.
- SILENT syndrome: Syndrome of Irreversible Lithium-Effectuated NeuroToxicity → chronic neurocognitive impairment despite stopping lithium.
- Renal impairment, hypothyroidism, hyperparathyroidism with long-term therapy.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
|
|
Categories
- A Level
- About
- Acute Medicine
- Anaesthetics and Critical Care
- Anatomy
- Anatomy and Physiology
- Biochemistry
- Book
- Cardiology
- Collections
- CompSci
- Crib Sheets
- Crib sheets
- Dental
- Dermatology
- Differentials
- Drugs
- ENT
- Education
- Electrocardiogram
- Embryology
- Emergency Medicine
- Endocrinology
- Ethics
- Foundation Doctors
- GCSE
- Gastroenterology
- General Practice
- Genetics
- Geriatric Medicine
- Guidelines
- Gynaecology
- Haematology
- Hepatology
- Immunology
- Infectious Diseases
- Infographic
- Investigations
- Lists
- Mandatory Training
- Medical Students
- Microbiology
- Nephrology
- Neurology
- Neurosurgery
- Nutrition
- OSCE
- OSCEs
- Obstetrics
- Obstetrics Gynaecology
- Oncology
- Ophthalmology
- Oral Medicine and Dentistry
- Orthopaedics
- Paediatrics
- Palliative
- Pathology
- Pharmacology
- Physiology
- Procedures
- Psychiatry
- Public Health
- Radiology
- Renal
- Respiratory
- Resuscitation
- Revision
- Rheumatology
- Statistics and Research
- Stroke
- Surgery
- Toxicology
- Trauma and Orthopaedics
- USMLE
- Urology
- Vascular Surgery