Podcast 795: Lithium Toxicity - The Emergency Medical Minute

Podcast 795: Lithium Toxicity

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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