12th March 2024

Lithium poisoning

As lithium is absorbed comparatively slowly, symptoms of poisoning often do not manifest until 12 hours or more after ingestion. Symptoms range from altered mental status to weakness, fasciculations, ataxia, vomiting and diarrhoea. Severe poisoning can cause convulsions, hypotension and dehydration. Lithium is excreted renally therefore, an increase in oral or IV fluids would increase elimination. Gastric lavage and/or whole bowel irrigation can be considered if within an hour of ingestion. Haemodialysis is the treatment of choice in severe poisoning and is indicated in those with reduced GCS, cerebellar signs or convulsions, regardless of lithium concentration. Lithium poisoning often occurs in the context of an insult to the kidneys precipitating toxicity in a chronic lithium user. Examples of these insults include acute infection, progressive CKD or commencement of new medications, especially NSAIDs and diuretics.