From the Guidelines
Lithium toxicity symptoms can be life-threatening and require immediate medical attention, with early signs including tremors, increased thirst, frequent urination, diarrhea, nausea, and vomiting, and severe symptoms including seizures, coma, cardiac arrhythmias, and even death 1.
Key Symptoms and Risk Factors
The symptoms of lithium toxicity can range from mild to severe and include:
- Tremors
- Increased thirst
- Frequent urination
- Diarrhea
- Nausea
- Vomiting
- Confusion
- Slurred speech
- Muscle weakness
- Drowsiness
- Lack of coordination Risk factors for lithium toxicity include:
- Dehydration
- Reduced kidney function
- Sodium depletion
- Drug interactions with medications like NSAIDs, ACE inhibitors, and diuretics
Monitoring and Prevention
Regular monitoring of lithium levels is essential for patients on this medication to prevent toxicity, especially when starting treatment or adjusting dosage 1.
Treatment
Treatment involves discontinuing lithium, providing supportive care, and in severe cases, hemodialysis to remove excess lithium from the bloodstream. It is crucial to weigh the risk-benefit of lithium in specific situations, especially in patients with chronic kidney disease, and to avoid using concomitant NSAIDs 1. Patients taking lithium should be advised to maintain hydration during intercurrent illness and to seek immediate medical attention if they experience any symptoms of lithium toxicity.
From the FDA Drug Label
ADVERSE REACTIONS Lithium toxicity: The likelihood of toxicity increases with increasing serum lithium levels. Serum lithium levels greater than 1.5 mEq/l carry a greater risk than lower levels. However, patients sensitive to lithium may exhibit toxic signs at serum levels below 1. 5 mEq/l. Diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination may be early signs of lithium toxicity, and can occur at lithium levels below 2 mEq/l. At higher levels, giddiness, ataxia, blurred vision, tinnitus and a large output of dilute urine may be seen. Information for the patients: Outpatients and their families should be warned that the patient must discontinue lithium therapy and contact his physician if such clinical signs of lithium toxicity as diarrhea, vomiting, tremor, mild ataxia, drowsiness, or muscular weakness occur
The symptoms of lithium toxicity include:
- Early signs:
- Diarrhea
- Vomiting
- Drowsiness
- Muscular weakness
- Lack of coordination
- Signs at higher levels:
- Giddiness
- Ataxia
- Blurred vision
- Tinnitus
- Large output of dilute urine These symptoms can occur at serum lithium levels below 2 mEq/l, and the risk of toxicity increases with increasing serum lithium levels 2.
From the Research
Lithium Toxicity Symptoms
Lithium toxicity can occur due to various reasons such as reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage 3. The symptoms of lithium toxicity can be severe and may include neurologic injury that can be permanent 3.
Common Symptoms
Some common symptoms of lithium toxicity include:
- Thirst and excessive urination
- Nausea and diarrhea
- Tremor
- Weight gain
- Cognitive impairment
- Neurological sequelae such as confusion, ataxia, and seizures 4
Severe Symptoms
Severe symptoms of lithium toxicity may include:
- Acute renal failure
- Hyperparathyroidism
- Lithium-induced hypothyroidism
- Neurological symptoms such as coma, seizures, and permanent brain damage 5, 6
Treatment
Treatment of lithium toxicity usually involves supportive care and hemodialysis to enhance the elimination of lithium from the body 3, 5. High-flux hemodialysis membranes can be effective in removing lithium from the body 5. The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup criteria can be used to determine the need for hemodialysis in patients with lithium toxicity 6.
Management Strategies
Management strategies for lithium toxicity include: