Lithium Toxicity

chronic, acute-on-chronic, acute

symptoms are predominately GI including nausea, vomiting, cramping, and sometimes diarrhea. Progression of acute toxicity can involve neuromuscular signs such as tremulousness, dystonia, hyperreflexia, and ataxia. Cardiac dysrhythmias have been reported but rarely occur.

GI and neurologic symptoms, and serum levels can be difficult to interpret

typically have a large body burden of lithium and may be difficult to treat. Chronic lithium toxicity is usually precipitated with introduction of new medication that may impair renal function/excretion or cause a hypovolemic state. Symptoms are primarily neurologic. Mental status is often altered and can progress to coma and seizures if the diagnosis is unrecognized.

1. decontamination: lavage if in 1st hour, WBI in first few hours
2. Diuresis: excretion is a function of GFR, so give high vol NS
3. consider dialysis for elevated Cr, Li 2.5 in chronic tox, Li 4 in acute tox, or for markedly altered MS or hemodynamic compromise