Lithium poisoning

T43.9 + (X44.99/X69.99/Y14.99)

DESCRIPTION

Lithium toxicity mostly occurs with chronic therapy and may be precipitated by decreased excretion due to renal dysfunction, diuresis, dehydration or drug-drug interactions (e.g. NSAIDs, diuretics, ACE-inhibitors and ARBs).

Signs and symptoms include :

  • nausea and vomiting
  • diarrhoea
  • nystagmus
  • CNS symptoms: tremor, hyperreflexia, choreoathetoid movements, fasciculations, ataxia, agitation, confusion and lethargy

In severe toxicity:

  • coma
  • seizures,
  • dysrhythmias
  • hypotension

GENERAL MEASURES

Whole bowel irrigation may be considered with a potentially toxic ingestion or ingestion of sustained-release products.

LoEIII [38]

Monitor:

  • Vitals signs, mental status and urine output
  • If available, do serial lithium levels 6 hourly until peaked and declining.
  • Electrolytes and renal function.
  • Fluid status: administer sodium chloride 0.9 % to maintain urine flow of 1–2 mL/kg/hour but prevent hypernatremia.
  • Cardiac function and treat dysrhythmias (see Cardiac dysrhythmias).
  • Thyroid function, in chronic toxicity.

MEDICINE TREATMENT

Correct electrolyte abnormalities: see Major electrolyte abnormalities.

For seizures: R56.8 + (T43.9/X44.99/X69.99/Y14.99)

Treat with benzodiazepines - see Status epilepticus.

Note: Phenytoin should be avoided (due to potential cardiotoxicity).

LoEIII [39]

REFERRAL

Early referral for haemodialysis is indicated in severe lithium poisoning and in patients with renal impairment. Discuss with a specialist.

LoEIII [40]