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
Lithium Poisoning Treatment
- No specific antidote is known for lithium poisoning 1
- Treatment for early symptoms involves reduction or cessation of dosage and resumption at a lower dose after 24 to 48 hours
- Treatment for severe cases involves:
- Gastric lavage
- Correction of fluid and electrolyte imbalance
- Regulation of kidney functioning
- Use of urea, mannitol, and aminophylline to increase lithium excretion
- Hemodialysis for rapid removal of the ion in severely toxic patients 1
From the Research
Lithium poisoning requires immediate medical attention, and treatment involves discontinuing lithium and providing supportive care, including IV fluids and potentially hemodialysis in severe cases, as recommended by the most recent and highest quality study 2.
Overview of Lithium Poisoning
Lithium poisoning occurs when a person has excessive levels of lithium in their bloodstream, typically above 1.5 mEq/L. Symptoms of lithium toxicity progress from mild (tremor, nausea, diarrhea, muscle weakness) to severe (confusion, seizures, coma, cardiac arrhythmias). Lithium has a narrow therapeutic window (0.6-1.2 mEq/L), making regular blood monitoring essential for patients taking it therapeutically.
Risk Factors and Prevention
Factors that increase the risk of lithium poisoning include dehydration, reduced kidney function, sodium depletion, and drug interactions with NSAIDs, diuretics, and ACE inhibitors. Prevention involves maintaining adequate hydration, following prescribed dosages, regular blood level monitoring, and avoiding medications that interact with lithium.
Treatment and Management
Treatment involves discontinuing lithium immediately and providing supportive care, including IV fluids to enhance lithium excretion through the kidneys. In severe cases (levels >4.0 mEq/L or significant symptoms), hemodialysis may be necessary to rapidly remove lithium from the blood, as supported by the EXTRIP workgroup recommendations 2. The decision to use extracorporeal treatments should take into account the lithium level, kidney function, pattern of lithium toxicity, patient's clinical status, and availability of extracorporeal treatments.
Recovery and Outcomes
Recovery from lithium poisoning depends on the severity of the toxicity but may take days to weeks, with some neurological effects potentially persisting longer. The incidence of persistent neurological deficits, such as cerebellar dysfunction, is poorly understood but appears to be uncommon in uncomplicated acute poisoning 3.
Key Considerations
- Severity of poisoning: Levels >4.0 mEq/L or significant symptoms require immediate attention and potentially hemodialysis.
- Kidney function: Impaired kidney function increases the risk of toxicity and affects treatment decisions.
- Supportive care: IV fluids and monitoring are crucial in managing lithium poisoning.
- Extracorporeal treatments: Hemodialysis is the preferred treatment for severe cases, with continuous RRT as an acceptable alternative 2.