Further Inpatient Care
Admit patients with significant signs or symptoms of toxicity.
Admit symptomatic patients, 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).
Further Outpatient Care
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.
Intentional overdose: Coordinate care with mental health care providers before discharge from the hospital.
Transfer
Transfer may be indicated if hemodialysis facilities are not available locally.
Complications
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
Prognosis
Most cases of lithium poisoning result in a favorable outcome; however, up to 10% of individuals with severe lithium toxicity develop chronic neurologic sequelae.
Linakis JG, Savitt DL, Wu TY, Lockhart GR, Lacouture PG. Use of sodium polystyrene sulfonate for reduction of plasma lithium concentrations after chronic lithium dosing in mice. J Toxicol Clin Toxicol. 1998;36(4):309-13. [Medline].
Ghannoum M, Lavergne V, Yue CS, Ayoub P, Perreault MM, Roy L. Successful treatment of lithium toxicity with sodium polystyrene sulfonate: a retrospective cohort study. Clin Toxicol (Phila). Jan 2010;48(1):34-41. [Medline].
Menghini VV, Albright RC Jr. Treatment of lithium intoxication with continuous venovenous hemodiafiltration. Am J Kidney Dis. Sep 2000;36(3):E21. [Medline].
van Bommel EF, Kalmeijer MD, Ponssen HH. Treatment of life-threatening lithium toxicity with high-volume continuous venovenous hemofiltration. Am J Nephrol. Sep-Oct 2000;20(5):408-11. [Medline].
Alexander MP, Farag YM, Mittal BV, Rennke HG, Singh AK. Lithium toxicity: a double-edged sword. Kidney Int. Jan 2008;73(2):233-7. [Medline].
Aral H, Vecchio-Sadus A. Toxicity of lithium to humans and the environment--a literature review. Ecotoxicol Environ Saf. Jul 2008;70(3):349-56. [Medline].
Burkhart, K. Lithium. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. Sixth Edition. Mosby Elsevier; 2006:2442-2444.
Chen KP, Shen WW, Lu ML. Implication of serum concentration monitoring in patients with lithium intoxication. Psychiatry Clin Neurosci. Feb 2004;58(1):25-9. [Medline].
Eyer F, Pfab R, Felgenhauer N, et al. Lithium poisoning: pharmacokinetics and clearance during different therapeutic measures. J Clin Psychopharmacol. Jun 2006;26(3):325-30. [Medline].
Freeman MP, Freeman SA. Lithium: clinical considerations in internal medicine. Am J Med. Jun 2006;119(6):478-81. [Medline].
Giles JJ, Bannigan JG. Tetatogenic and developmental effects of lithium. Curr Pharm Des. 2006;12(12):1531-41.
Gitlin M. Lithium and the kidney: an updated review. Drug Saf. Mar 1999;20(3):231-43. [Medline].
Greller H. Lithium. In: Goldfrank's Toxicologic Emergencies. Eighth. McGraw-Hill; 2006:1052-1058.
Groleau G. Lithium toxicity. Emerg Med Clin North Am. May 1994;12(2):511-31. [Medline].
Hsu CH, Liu PY, Chen JH, Yeh TL, Tsai HY, Lin LJ. Electrocardiographic abnormalities as predictors for over-range lithium levels. Cardiology. 2005;103(2):101-6. [Medline].
Juurlink DN, Mamdani MM, Kopp A, Rochon PA, Shulman KI, Redelmeier DA. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc. May 2004;52(5):794-8. [Medline].
Lee DC, Klachko MN. Falsely elevated lithium levels in plasma samples obtained in lithium containing tubes. J Toxicol Clin Toxicol. 1996;34(4):467-9. [Medline].
Ng YW, Tiu SC, Choi KL, Chan FK, Choi CH, Kong PS. Use of lithium in the treatment of thyrotoxicosis. Hong Kong Med J. Aug 2006;12(4):254-9. [Medline].
Rosenqvist M, Bergfeldt L, Aili H, Mathe AA. Sinus node dysfunction during long-term lithium treatment. Br Heart J. Oct 1993;70(4):371-5. [Medline].
Scharman EJ. Methods used to decrease lithium absorption or enhance elimination. J Toxicol Clin Toxicol. 1997;35(6):601-8. [Medline].
Timmer RT, Sands JM. Lithium intoxication. J Am Soc Nephrol. Mar 1999;10(3):666-74. [Medline].
Zimmerman JL. Poisonings and overdoses in the intensive care unit: general and specific management issues. Crit Care Med. Dec 2003;31(12):2794-801. [Medline].

