CONTENTS


pharmacokinetics

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absorption
distribution
elimination

presentations

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spectrum of symptoms that may be seen:
there are roughly three forms of lithium intoxication

evaluation

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The differential diagnosis and evaluation will vary considerably, depending on the clinical presentation.  Some common considerations include:

basic evaluations for all patients
additional evaluations to consider in acute ingestion
additional evaluations to consider in chronic intoxication

lithium levels & ingested doses

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when to obtain levels & how often

interpretation of lithium levels
interpretation of the ingested dose

decontamination

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avoid medications which impair lithium excretion

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medications which increase lithium levels

fluid resuscitation & diuresis

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aggressive fluid repletion
maintenance fluid infusion

diuretics?

nephrogenic diabetes insipidus

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dialysis

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widespread confusion exists regarding when to dialyze 

factors to consider when deciding whether to dialyze
bottom line on dialysis?

Given that the time course of lithium poisoning is relatively long compared to other poisons, evolving over days, it is not unreasonable that a conservative approach is initially adopted in some circumstances as long as frequent monitoring of renal function and serum lithium concentrations are performed so that treatment can be adjusted, if required.  –Roberts 2014


resumption of lithium

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prognosis & SILENT syndrome

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mortality
SILENT (Syndrome of Irreversible Lithium-Effectuated NeuroToxicity)

While hyperlithemia can be toxic, its rapid correction can be more toxic. –Swartz et al. 1994


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questions & discussion

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Going further

References

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  • 08721895  Swartz CM, Dolinar LJ. Encephalopathy associated with rapid decrease of high levels of lithium. Ann Clin Psychiatry. 1995 Dec;7(4):207-9. doi: 10.3109/10401239509149627  [PubMed]
  • 11105800  Bailey B, McGuigan M. Comparison of patients hemodialyzed for lithium poisoning and those for whom dialysis was recommended by PCC but not done: what lesson can we learn? Clin Nephrol. 2000 Nov;54(5):388-92  [PubMed]
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  • 24655138  Roberts DM, Gosselin S. Variability in the management of lithium poisoning. Semin Dial. 2014 Jul-Aug;27(4):390-4. doi: 10.1111/sdi.12235  [PubMed]
  • 25583292  Decker BS, Goldfarb DS, Dargan PI, Friesen M, Gosselin S, Hoffman RS, Lavergne V, Nolin TD, Ghannoum M; EXTRIP Workgroup. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol. 2015 May 7;10(5):875-87. doi: 10.2215/CJN.10021014  [PubMed]
  • 27516079  Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium Poisoning. J Intensive Care Med. 2017 May;32(4):249-263. doi: 10.1177/0885066616651582  [PubMed]
  • 31378954  Vodovar D, Beaune S, Langrand J, Vicaut E, Labat L, Mégarbane B. Assessment of Extracorporeal Treatments in Poisoning criteria for the decision of extracorporeal toxin removal in lithium poisoning. Br J Clin Pharmacol. 2020 Mar;86(3):560-568. doi: 10.1111/bcp.14087  [PubMed]