Lithium toxicity (quick review)

2 Jul

Medications that interact with lithium found in 50% cases (even as basic as NSAIDs).


Narrow therapeutic index.


Frequency of signs / symptoms based on retrospective review:

  • Tremor 51%
  • Confusion 44%
  • Ataxia 38%
  • Drowsy 36%
  • Anorexia 29%
  • Nausea/diarrhea 27%
  • Fatigue 25%
  • Lethargy 23%
  • Slurred speech 19%
  • Seizure 4%


Dialysis indications:

  • Lithium level >4 in acute overdose (3.5 in chronic)
  • Little change in lithium level after 6 hours of NS invusion
  • Sustained lithium level >1.0 after 36 hours
  • AKI / ESRD
  • Sustained release formulations


A recent retrospective analysis of 205 cases of lithium toxicity found no detectable difference in outcome for patients treated with dialysis and patients not so treated.


Submitted by J. Andrick.


References: The incidence and clinical correlates of lithium toxicity: a retrospective review. – Dennison U – Ir; J Med Sci – 01-SEP-2011; 180(3): 661-5; Comparison of patients hemodialyzed for lithium poisoning and those for whom dialysis was recommended by PCC but not done: what lesson can we learn? Bailey B, McGuigan M. Clin Nephrol.; picture



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