Isr Med Assoc J 2002;4:265-7. Although risk factors for lithium intoxication seem to be well-described, lacking patient education and inexperience of treatment are assumed to contribute to the probability of lithium … Both intentional acute intoxication as well as chronic toxicity can be seen. Am J Psychiatry 2004;161:217-22. A kinetic study in 14 cases of lithium poisoning. Lithium has a predilection for accumulation in the liver, muscle, brain, kidn, Neurologic symptoms include coarse tremor, dysarthria, ataxia, … Lithium: acute overdose is usually benign if adequate hydration is maintained and renal function is normal; chronic toxicity can be difficult … Emergency interventions for a lithium overdose will be determined by the severity of the toxicity. Some symptoms may last for a year after levels return to normal. Lithium toxicity, also known as lithium overdose, is the condition of having too much lithium. Jaeger A, Sauder P, Kopferschmitt J, Tritsch L, Flesch F. When should dialysis be performed in lithium poisoning? The catheter can be in and out in a day and dialysis is usually very well tolerated. Serious arrhythmias are unusual but can be present. J Toxicol Clin Toxicol 1997;35:601-8. The management of lithium intoxication includes stopping the offending medication, supportive care, and, in selected cases, renal replacement therapy such as hemodialysis . ECTR is recommended. Lithium was discovered in 1818, but it was in the 1950s that Cade and Schou established its use in bipolar disorders. Objectives : To describe the available and relevant literature on the management of Lithium poisoning. If kidney function is impaired and the [Li+].>4.0 mEq/L (1D) In the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of [Li+] (1D) J Am Soc Nephrol 1999;10:666-74. The use of lithium levels in the emergency department. Patient’s need to be to awake and cooperative for it to be used safely.The renal fellow’s pager often goes off as dialysis is an excellent way of removing lithium. Roberts DM(1), Gosselin S. Author information: (1)Department of Renal Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom; Burns, Trauma and Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia. Meltzer E, Steinlauf S. The clinical manifestations of lithium intoxication. You don’t want to see a patient end up with long term neurotoxicity after sitting on the fence and deciding against HD.As mentioned above, because Li has a relatively large volume of distribution and checking levels 4-6 hours after dialysis are recommended as “rebound” may occur as Li moves into the intravascular space potentially requiring further therapy.Another attending pearl: In severe cases particularly in patients with poor renal function, check a Li level on dialysis from the arterial port an hour before stopping so the lab has time to come back before you end HD. If you’re patient still has a Li level >1 mEq/L extend the session as you’re going to see some rebound and that intra-dialysis level is as good as you’re going to get if native clearance is poor. Management of patients with severe lithium poisoning begins with supportive care, including discontinuation of lithium and volume resuscitation with intravenous isotonic saline (14,21). Lithium has been used as the gold standard in the treatment of major depressive and bipolar disorders for decades. Lancet 2012;379:721-8. If it is chronic toxicity-related, meaning due to a build up of toxins in the blood, treatment may involve simply reducing or stopping the lithium dosing until serum levels are normal. With a low molecular weight and negligible protein binding lithium is easily removed from the blood as A pearl from one of my attendings: When in doubt, dialyze. With a low molecular weight and negligible protein binding lithium is easily removed from the blood as outlined by Nate.However, with a relatively large volume of distribution of 0.6-0.9 L/kg it often requires prolonged or repeated HD sessions to deplete Lithium stores. Due to its narrow therapeutic index, lithium toxicity is a common clinical problem. Kidney Int 2010;77:219-24. The renal fellow’s pager often goes off as dialysis is an excellent way of removing lithium. EKG changes including QT prolongation, T wave flattening and ST depression can occur.