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Lithium Poisoning

Lithium Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • 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 or chronic conditions affecting lithium clearance
  • Overdose

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Rosen, Peter, et al., editors. "Lithium Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning.
Lithium Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning. Accessed April 22, 2019.
Lithium Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning
Lithium Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lithium Poisoning ID - 307343 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -