From the Guidelines
Management of lithium overdose requires immediate medical attention, focusing on supportive care, enhanced elimination, and close monitoring, with an emphasis on correcting dehydration, assessing airway, breathing, and circulation, and providing intravenous fluids. The initial approach should include discontinuing lithium and assessing the patient's overall condition. Key aspects of management include:
- Discontinuing lithium to prevent further absorption
- Assessing airway, breathing, and circulation (ABCs) to ensure patient stability
- Providing intravenous fluids, such as normal saline, to correct dehydration and enhance lithium excretion
- Considering gastric lavage if the patient presents within 1-2 hours of ingestion, though its efficacy is limited
- Noting that activated charcoal is not effective for lithium absorption
- Recognizing that hemodialysis is the most effective method for lithium removal, indicated for severe toxicity (serum levels >4.0 mEq/L), significant clinical symptoms, or renal impairment
- Implementing continuous cardiac monitoring due to potential cardiac arrhythmias
- Frequently checking serum lithium levels, as they may continue to rise hours after ingestion due to delayed absorption from sustained-release formulations
- Monitoring electrolytes, renal function, and thyroid function
- Regularly assessing neurological status, as lithium toxicity can cause confusion, tremors, seizures, and coma
- Using benzodiazepines for symptomatic treatment of seizures and agitation, as supported by general medical knowledge and principles of toxicology management 1. The most critical lab tests after lithium overdose include serum lithium levels, electrolytes, renal function tests, and thyroid function tests, which are essential for monitoring the patient's condition and guiding treatment. It is crucial to prioritize these tests to ensure timely and appropriate management, focusing on reducing morbidity, mortality, and improving the quality of life for the patient.
From the FDA Drug Label
The toxic levels for lithium are close to the therapeutic levels. It is therefore important that patients and their families be cautioned to watch for early symptoms and to discontinue the drug and inform the physician should they occur. Treatment: No specific antidote for lithium poisoning is known Early symptoms of lithium toxicity can usually be treated by reduction or cessation of dosage of the drug and resumption of the treatment at a lower dose after 24 to 48 hours. In severe cases of lithium poisoning, the first and foremost goal of treatment consists of elimination of this ion from the patient Treatment is essentially the same as that used in barbiturate poisoning: 1) gastric lavage, 2) correction of fluid and electrolyte imbalance and 3) regulation of kidney functioning. Urea, mannitol, and aminophylline all produce significant increases in lithium excretion. Hemodialysis is an effective and rapid means of removing the ion from the severely toxic patient Infection prophylaxis, regular chest X-rays, and preservation of adequate respiration are essential.
The management approach for a patient with a lithium overdose involves:
- Monitoring for early symptoms of lithium toxicity
- Discontinuation of the drug
- Reduction or cessation of dosage
- Correction of fluid and electrolyte imbalance
- Regulation of kidney functioning
- Gastric lavage in severe cases
- Hemodialysis in severely toxic patients
- Infection prophylaxis, regular chest X-rays, and preservation of adequate respiration 2
From the Research
Management Approach for Lithium Overdose
The management approach for a patient with a lithium overdose involves several key steps, including:
- Enhanced lithium clearance to minimize exposure to high tissue concentrations 3
- Consideration of the patient's risk factors, such as chronic or acute-on-therapeutic toxicity, clinically significant features, and serum lithium concentration >2.5 mmol/L 3
- Choice of treatment, including haemodialysis, continuous arteriovenous haemodiafiltration, and continuous venovenous haemodiafiltration, depending on local accessibility and urgency 3
Lab Tests for Lithium Overdose
Lab tests for a patient with a lithium overdose may include:
- Serum lithium concentration to assess the level of toxicity 3
- Blood urea nitrogen (BUN), creatinine, and estimated glomerular filtration rate (eGFR) to monitor renal function 4, 5, 6
- Urinalysis, including protein/creatinine ratio, to detect lithium-induced nephropathy 4
- Spot urine protein/creatinine ratio, a cost-effective and practical laboratory test to monitor lithium-treated patients 4
Monitoring Kidney Function
Monitoring kidney function is crucial in patients taking lithium, as it can cause renal impairment and chronic kidney disease 7, 4, 5, 6. Regular monitoring of kidney function may include: