Lithium Toxicity

Question 1

What can precipitate lithium toxicity?

Answer 1

Dehydration

Renal failure

Diuretics (especially Bendroflumethiazide)

Ace inhibitors

Metronidazole.

Question 2

What are asome features of lithium toxicity?

Answer 2

• Coarse tremor (a fine tremor is seen in therapeutic levels)
• Hyperreflexia
• Acute confusion
• Seizure
• Coma

Question 3

How do you manage lithium toxicity?

Answer 3

• Mild-moderate toxicity may respond to volume resuscitation with normal saline
• Haemodialysis may be needed in severe toxicity
• Sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion