Lithium Poisoning
Basics
Description
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
Etiology
- Acute or chronic conditions affecting lithium clearance
- Overdose
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Citation
Schaider, Jeffrey J., et al., editors. "Lithium Poisoning." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning.
Lithium Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning. Accessed November 8, 2024.
Lithium Poisoning. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning
Lithium Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 08]. 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
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T1 - Lithium Poisoning
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ED - Barkin,Adam Z,
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ED - Schaider,Jeffrey J,
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307343/all/Lithium_Poisoning
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
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