lithium toxicity

pharmacology

• Handling: Handled by the kidney exactly like Sodium.
• Risk Factors: Dehydration, Hyponatraemia, Thiazides, ACEi/ARBs, NSAIDs (reduce clearance).

clinical presentation

• Acute: GI predominant (Nausea, Vomiting, Diarrhoea). Delayed neuro symptoms.
• Chronic: Neuro predominant (Tremor, Hyperreflexia, Ataxia, Confusion, Seizures). Occurs at lower levels.

management

1. decontamination

• Activated Charcoal: Ineffective (does not bind metals).
• Whole Bowel Irrigation (PEG): Consider for large acute ingestions (sustained release).

2. elimination

• Fluid Resuscitation: Normal Saline. (Restoring GFR + Sodium load promotes excretion).
• Haemodialysis: The definitive clearance method.
  • Indications:
    • Severe neurological impairment (coma, seizures).
    • Renal failure (cannot clear).
    • Levels: > 4.0 mmol/L (Acute) or > 2.5 mmol/L (Chronic).

SILENT syndrome

Syndrome of Irreversible Lithium-Effectuated NeuroToxicity. Permanent cerebellar sequelae (ataxia, dysarthria) after severe toxicity.