Lithium Toxicity Follow-up

Updated: Jun 02, 2017
  • Author: David C Lee, MD; Chief Editor: Michael A Miller, MD  more...
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Follow-up

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.

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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)
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Transfer

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

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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
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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.

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