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Lithium Toxicity

Practice Essentials

Lithium is commonly used as maintenance treatment of bipolar disorder. Toxicity occurs frequently, since lithium is used in a population at high risk for overdose. Furthermore, lithium has a relatively narrow therapeutic index that predisposes patients on lithium maintenance treatment to poisoning with relatively minor changes in medications or health status.

Clinically, the three main categories of lithium poisoning are as follows (see Presentation):

Acute – Manifestations are predominantly gastrointestinal (GI), but progression to neuromuscular signs may occur

Acute-on-chronic – Both GI and neurologic manifestations may be present

Chronic – Manifestations are primarily neurologic

Lithium levels should be measured in symptomatic patients. However, levels may not correlate with clinical symptoms due to the kinetic profile of lithium. Multiple measurements may be indicated to evaluate the effects of treatment and in patients who have taken sustained-release tablets (see Workup).

Supportive therapy is the mainstay of treatment of lithium toxicity. Airway protection is crucial due to emesis and risk of aspiration. Seizures can be controlled with benzodiazepines, phenobarbital, or propofol. See Treatment.

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