Emergency Medical Minute5 Juli 2022

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.

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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