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Toxicology – Lithium Toxicity
Source
Lithium carbonate is commonly prescribed for bipolar disorder. It is also used in industrial settings, including fireworks production.
Typical Presentation
Toxicity may occur from acute overdose, chronic accumulation, or a combination of both. Patients on long-term therapy are especially at risk if kidney function declines or if interacting medications are introduced.
Clinical Features
Lithium toxicity presents in three main patterns:
Lithium affects multiple intracellular pathways, including inhibition of signaling systems and neurotransmitter modulation. It is eliminated almost entirely by the kidneys, making renal function a key factor in toxicity.
Management
Treatment is supportive and focuses on enhancing elimination:
Source
Lithium carbonate is commonly prescribed for bipolar disorder. It is also used in industrial settings, including fireworks production.
Typical Presentation
Toxicity may occur from acute overdose, chronic accumulation, or a combination of both. Patients on long-term therapy are especially at risk if kidney function declines or if interacting medications are introduced.
Clinical Features
Lithium toxicity presents in three main patterns:
- Acute toxicity: Predominantly gastrointestinal symptoms such as nausea, vomiting, diarrhea, and dizziness. Kidney injury and mild cardiac changes (e.g., QT prolongation) may occur.
- Chronic toxicity: Mainly neurological symptoms including tremor, weakness, hyperreflexia, involuntary movements, poor coordination, confusion, and altered consciousness, which can progress to coma.
- Acute-on-chronic toxicity: A combination of both GI and neurological symptoms, often more severe.
Lithium affects multiple intracellular pathways, including inhibition of signaling systems and neurotransmitter modulation. It is eliminated almost entirely by the kidneys, making renal function a key factor in toxicity.
Management
Treatment is supportive and focuses on enhancing elimination:
- IV fluids to improve kidney perfusion and promote excretion
- Whole bowel irrigation for sustained-release ingestion
- Hemodialysis for severe cases (e.g., high lithium levels, neurological symptoms, or kidney impairment)
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- Toxicity risk increases with dehydration, kidney dysfunction, and certain medications (e.g., NSAIDs, ACE inhibitors).
- Neurological symptoms are more prominent in chronic toxicity.
- Lithium levels may rise again after dialysis, requiring repeated treatments.
- Activated charcoal is not effective for lithium overdose.
- Therapeutic levels are typically 0.6–1.2 mEq/L.
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