Management of lithium intoxication

Abstract

SUMMARY Lithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.

Lithium: how low can you go?

“…Of 77 patients with high lithium levels reviewed, over one third required intensive care treatment and 13% received haemodialysis, although all recovered with limited apparent chronic impact on renal function (Ott et al 2016). Management strategies for toxicity are available (Murphy et al 2023).…”

Rhyme or reason in therapeutics

“…Lithium has numerous molecular targets but potentially its most devastating effect is on cerebellar granule neurons during episodes of toxicity. Murphy et al (2023) review the management of lithium toxicity. All doctors should be aware of the signs of toxicity that require immediate cessation of lithium (vomiting, cerebellar signs or impaired consciousness) and the situations that may lead to it.…”

Tercer Consenso Argentino sobre el manejo de los Trastornos Bipolares. Segunda Parte B

“…Los niveles séricos terapéuticos recomendados por las principales guías de tratamiento para el TB -como es el caso de las guías CANMAT o las de la Asociación Británica de Psicofarmacología (British Association for Psychopharmacology guidelines)-son de aproximadamente 0.6 a 1.2 mmol/L (Goodwin, 2016). Sin embargo, la toxicidad se puede producir a concentraciones superiores a 1.5 mmol/L (Murphy et al, 2022).…”

“…Del mismo modo, y teniendo en cuenta el momento de aparición (Murphy et al, 2022), los eventos adversos pueden clasificarse en: ■ Asociados al tratamiento agudo. ■ Asociados al tratamiento crónico.…”