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Lithium Toxicity Follow-up

  • Author: David C Lee, MD; Chief Editor: Asim Tarabar, MD  more...
Updated: Feb 02, 2015

Further Outpatient Care

Discharge planning varies, depending on whether the overdose was unintentional or intentional. In unintentional overdose, asymptomatic patients and patients with serum lithium concentrations in the therapeutic range and minor toxicity may be discharged with scheduled follow-up in 1-2 days. In intentional overdose, coordinate care with mental health care providers before discharging the patient from the hospital.


Further Inpatient Care

Indications for hospital admission are as follows:

  • Admit patients with significant signs or symptoms of toxicity, regardless of serum lithium levels
  • Admit patients on chronic lithium therapy with serum lithium levels higher than 2 mEq/L
  • Admit patients with signs of severe neurotoxicity pending hemodialysis to an intensive care unit (ICU)


Transfer may be indicated if hemodialysis facilities are not available locally.



Complications of lithium toxicity may include the following:

  • Truncal and gait ataxia
  • Nystagmus
  • Short-term memory deficits
  • Dementia
  • SILENT (syndrome of irreversible lithium-effectuated neurotoxicity) syndrome


Most cases of lithium poisoning result in a favorable outcome; however, up to 10% of individuals with severe lithium toxicity develop chronic neurologic sequelae.

Contributor Information and Disclosures

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


Amit Gupta, MD Department of Emergency Medicine, Staten Island University Hospital

Amit Gupta, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Mark S Slabinski, MD, FACEP, FAAEM Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Ohio State Medical Association

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, James G Linakis, PhD, MD, to the development and writing of this article.

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