Lithium Poisoning
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Basics
Description
- GI absorption is rapid:
- Regular release: Peak serum levels 2–4 hr
- Sustained release: Peak serum levels 4–12 hr
- Half-life 24 hr
- Slow distribution (at least 6 hr)
- Volume of distribution 0.6–0.9 L/kg
- Elimination:
- Not metabolized
- Renal excretion (unchanged)
- Reabsorbed in the proximal tubules by sodium transport mechanism
- Elimination half-life (therapeutic) is 20–24 hr and prolonged in chronic users
- Therapeutic and toxic indices:
- Therapeutic and toxic effects occur only when lithium is intracellular
- Narrow toxic-to-therapeutic ratio
- Therapeutic level 0.6–1.2 mEq/L (postdistribution)
- Because of small size, renal handling is similar to sodium, potassium, and magnesium
- Risk factors:
- Acute conditions increasing risk of toxicity:
- Dehydration (larger percent reabsorbed)
- Overdose
- Chronic conditions:
- Hypertension
- Diabetes mellitus
- Renal failure
- Congestive heart failure
- Advanced age
- Dose change
- Drug interactions
- Lithium therapy
- Low-salt diet
- The following may result in increased serum lithium levels due to decreased renal clearance or exacerbated effects:
- NSAIDs
- Thiazide diuretics
- ACE inhibitors
- Phenytoin
- Tricyclic antidepressants
- Phenothiazines
- Acute conditions increasing risk of toxicity:
Etiology
- Acute or chronic conditions affecting lithium clearance
- Overdose
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- GI absorption is rapid:
- Regular release: Peak serum levels 2–4 hr
- Sustained release: Peak serum levels 4–12 hr
- Half-life 24 hr
- Slow distribution (at least 6 hr)
- Volume of distribution 0.6–0.9 L/kg
- Elimination:
- Not metabolized
- Renal excretion (unchanged)
- Reabsorbed in the proximal tubules by sodium transport mechanism
- Elimination half-life (therapeutic) is 20–24 hr and prolonged in chronic users
- Therapeutic and toxic indices:
- Therapeutic and toxic effects occur only when lithium is intracellular
- Narrow toxic-to-therapeutic ratio
- Therapeutic level 0.6–1.2 mEq/L (postdistribution)
- Because of small size, renal handling is similar to sodium, potassium, and magnesium
- Risk factors:
- Acute conditions increasing risk of toxicity:
- Dehydration (larger percent reabsorbed)
- Overdose
- Chronic conditions:
- Hypertension
- Diabetes mellitus
- Renal failure
- Congestive heart failure
- Advanced age
- Dose change
- Drug interactions
- Lithium therapy
- Low-salt diet
- The following may result in increased serum lithium levels due to decreased renal clearance or exacerbated effects:
- NSAIDs
- Thiazide diuretics
- ACE inhibitors
- Phenytoin
- Tricyclic antidepressants
- Phenothiazines
- Acute conditions increasing risk of toxicity:
Etiology
- Acute or chronic conditions affecting lithium clearance
- Overdose
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