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
  • 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
  • Gastrointestinal
    • Nausea, vomiting, abdominal pain
  • Neurological
    • Tremor, nystagmus, CNS depression (late finding)
  • Cardiovascular
    • Bradycardia, QT prolongation, EKG changes
• Treatment for lithium toxicity
  • ABCs
  • Get a good history
  • GI Decontamination:
    • Whole bowel irrigation if patient ingested extended-release tablets
  • Dialysis
    • 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.

Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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