Emergency Medicine Blog Tox Pearls: Lithium Toxicity

Female holds pills of different color in hand.

April 19, 2019

Do you have a psychiatric patient with tremors, ataxia, or fasciculations? Think Lithium!

Clinical findings include:

GI symptoms (nausea/vomiting)
EKG changes (including prolonged QTc)

Neurologic changes from subtle symptoms like sluggishness or confusion to seizures and encephalopathy (late signs!)

When in doubt - check a level

Therapeutic level: 0.8 - 1.2 mEq/L

Toxicity:
Mild 1.5 - 2.5 mEq/L
Moderate 2.5 - 3.5 mEq/L
Severe > 3.5 mEq/L

Treatment

ABCs and supportive care
Benzos for seizure

Hydration with Normal Saline to increase Li clearance
Follow the sodium, as Li can cause diabetes insipidus and hypernatremia

Gi Decontamination
No role for charcoal!
In acute ingestion, whole bowel irrigation

Indications for hemodialysis:
Serum concentration > 5 mEq/L
Serum concentration > 4 mEq/L with impaired renal clearance
Decreased level of consciousness or seizures
Symptomatic patients with concentration > 2.5 mEq/L, as well as impaired renal clearance or unable to received IV fluids

References: https://www.uptodate.com/contents/lithium-poisoning

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

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