J Toxicol Clin Toxicol. [Medline]. Lithium is a univalent cation of the white metal series, closely related to both sodium and potassium, but having no known role in human physiology. Lithium toxicity diagnosis Initially, the investigation should include cardiac monitoring, electrocardiogram (ECG), assessment of oxygenation and monitoring of urine output, serum electrolytes, calcium, renal function, glucose, serum lithium level, and thyroid-stimulating hormone. A United Kingdom study of patients taking lithium reported greater risk of development of renal disorders in women than in men, with women younger than 60 years at … Bendz H, Aurell M, Lanke J. Walker RJ, Weggery S, Bedford JJ, et al. 5 (6):000843. Lithium-induced nephropathy: Rate of progression and prognostic factors. 2010 Jan. 48(1):34-41. Am J Kidney Dis. [Full Text]. 78 (8):e980-e985. Cardiac dysrhythmias have been reported but rarely occur. [Medline]. Persistent nephrogenic diabetes insipidus following lithium therapy. News, encoded search term (Lithium Toxicity) and Lithium Toxicity. 2013 May. Cardiology. Crit Care Resusc. [Medline]. The toxic concentrations for Lithium (≥1.5 mEq/L) are close to the therapeutic range (0.8 to 1.2mEq/L). [Medline]. [Medline]. Clin J Am Soc Nephrol. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. The acronym … 45(4):626-37. Am J Physiol Renal Physiol. 1997 Jan. 54(1):9-13; discussion 14-5. Available at http://www.aapcc.org/annual-reports/. 290(5):F1222-33. 2005 Jan. 67(1):291-4. for: Medscape. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. 34(4):467-9. Following a cross-sectional study showing that use of statins is associated with lower NDI risk, an international group has initiated a randomized controlled study in lithium users who have indicators of NDI, to determine whether atorvastatin improves urine osmolality and aquaporin excretion. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODE1NTIzLWNsaW5pY2Fs, Diuretics that promote renal sodium wasting, Angiotensin-converting enzyme (ACE) inhibitors that reduce glomerular filtration rate (GFR) and enhance the tubular reabsorption of lithium, Nonsteroidal anti-inflammatory drugs (NSAIDs) that reduce the glomerular filtration rate (GFR) and interrupt of renal prostaglandin synthesis. Acute lithium toxicity is generally subdivided into three grades … New York: McGraw-Hill Education; 2019. Three main categories of lithium poisoning are as follows: acute, acute-on-chronic, and chronic. 2000 Sep-Oct. 20(5):408-11. Bretaudeau Deguigne M, Hamel JF, Boels D, Harry P. Lithium poisoning: the value of early digestive tract decontamination. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. 28(3):227-44. The most commo… Proc Natl Acad Sci U S A. de Groot T, Doornebal J, Christensen BM, Cockx S, Sinke AP, Baumgarten R, et al. Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, Phi Beta KappaDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology
Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc
Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont. Hsu CH, Liu PY, Chen JH, Yeh TL, Tsai HY, Lin LJ. 17(4):1063-72. Our aim was to detect predicting factors of lithium neurotoxicity at normal serum lithium levels in order to allow prevention of those constellations. David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. 35(2):278-80. Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, Central Society for Clinical and Translational ResearchDisclosure: Nothing to disclose. 2010 Nov-Dec. 23 Suppl 16:S43-8. Michael A Miller, MD Clinical Professor of Emergency Medicine, Medical Toxicologist, Department of Emergency Medicine, Texas A&M Health Sciences Center; CHRISTUS Spohn Emergency Medicine Residency Program [Medline]. Am J Kidney Dis. 386 (9992):461-8. Falsely elevated lithium levels in plasma samples obtained in lithium containing tubes. Lithium toxicity can occur due to excessive intake or decreased … Brain lithium levels were measured using 7-lithium magnetic resonance spectroscopy, a test that is used in research but is not available in clinical practice, said Dr. Forester. Li Y, Shaw S, Kamsteeg EJ, et al. Lancet. Pflugers Arch. 438(2):159-64. 32 (4):249-263. Wilting I, Baumgarten R, Movig KL, et al. In 2016, there were 6901 cases of lithium intoxication reported to the American Association of Poison Control Centers [4-6]. SAGE Open Med Case Rep. 2020. 2003 Aug. 64 (2):585-92. These patients typically have a large body burden of lithium and may be difficult to treat. Presne C, Fakhouri F, Noël LH, Stengel B, Even C, Kreis H, et al. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Treatment of lithium intoxication with continuous venovenous hemodiafiltration. Electrocardiographic abnormalities as predictors for over-range lithium levels. Symptoms may include a tremor, increased reflexes, trouble walking, kidney problems, and an altered level of consciousness. [Medline]. As with all toxic ingestions, it is important to determine the amount, time, co-ingestants, and reason for ingestion. Progression of acute toxicity can involve neuromuscular signs such as tremulousness, dystonia, hyperreflexia, and ataxia. Other possible risk factors include age, episodes of lithium intoxication and comorbid disorders. [Medline]. Fast Five Quiz: Are You Prepared to See Patients With Bipolar Disorder? Lithium toxicity, also known as lithium overdose, is the condition of having too much lithium. Toxicity does not often correlate with the measured lithium level since clinical toxicity is affected by the type of the poisoning. 2007 Apr. Signs and symptoms of chronic lithium toxicity are primarily neurologic. Acute. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. [Medline]. [Medline]. 23(6):811-5. Lithium intoxication is an important complication of its frequent use and narrow therapeutic index. Clifford C Dacso, MD, MPH, MBA John S Dunn Sr Research Chair, The Methodist Hospital Research Institute; Distinguished Research Professor, University of Houston 8:2050313X20953000. Supportive care for lithium intoxication includes prevention of further absorption and methods to increase enteric and renal excretion. Lithium has been used in medicine since the 1870s. SIgns and symptoms are predominantly gastrointestinal (GI), including nausea, vomiting, cramping, and sometimes diarrhea. 2017 Sep/Oct. Roque A, Herédia V, Ramalho M, de Campos R, Ferreira A, Azevedo R, et al. 2011 Jun 30. J Intensive Care Med. If you log out, you will be required to enter your username and password the next time you visit. [Medline]. Eur J Case Rep Intern Med. Amit Gupta, MD is a member of the following medical societies: American College of Emergency PhysiciansDisclosure: Nothing to disclose. Lithium-induced NDI in rats is associated with loss of alpha-ENaC regulation by aldosterone in CCD. Lithium intoxication. Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, et al. Complications may include serotonin syndrome. Patients who are on long-term lithium therapy can develop localized edema, dermatitis, and skin ulcers. zyprexa-relprevv-olanzapine-342979
Lithium intoxication has also been reported with the use of the nonsteroidal anti-inflammatory drug (NSAID) piroxicam.49,5° Studies in humans have shown that both indomethacin and diclofenac, two classes of NSAIDs, raise plasma lithium levels and decrease lithium clearance.51,52 A number of other NSAIDs have been shown to increase lithium levels in normal volunteers and patients … Lithium has a low therapeutic index; monitor levels closely to prevent acute lithium intoxication. Neurologic effects of lithium toxicity include the following: Gastrointestinal effects of lithium toxicity include the following: Mild-to-moderate lithium toxicity is characterized by tremor, weakness, and mild confusion. Grünfeld JP, Rossier BC. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. 375 (20):2008-2009. [Full Text]. The most common electrocardiographic finding is T-wave flattening. Please confirm that you would like to log out of Medscape. American Society of Health-System Pharmacists, American College of Occupational and Environmental Medicine. The case highlights the need to monitor clinical symptoms of intoxication in all patients taking lithium, regardless of their blood level, and to inform patients, family members, and general physicians about the symptoms and management of lithium intoxication. 1998. Pharmacotherapy. Rej S, Herrmann N, Shulman K, Fischer HD, Fung K, Harel Z, et al. Please confirm that you would like to log out of Medscape. John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals 39:425-42. N Engl J Med. 2016 Nov 17. Lithium toxicity should be considered in the context of both chronic intoxication and acute ingestion. Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects of Amiloride. [Medline]. Toxicity has been observed with levels as low as 1 mmol/L. Le suivi thérapeutique des patients sous lithium comprend des taux sériques résiduels hebdomadaires lors de l'introduction du traitement, puis mensuels. The main patient-related factor that places a patient at an increased risk for lithium intoxication, thus, might be summarized as a lack of lithium-related knowledge, which is known to be negatively correlated with age, whereas duration of treatment, sex, education and diagnosis does not seem to be related to lithium-specific knowledge (Schaub et al. Lithium effect on renal glomerular function in individuals with intellectual disability. Clin J Am Soc Nephrol. Am J Kidney Dis. 29(3):296-9. These patients take lithium regularly and have taken a larger dose recently. van Bommel EF, Kalmeijer MD, Ponssen HH. Acute exposure to lithium can cause leukocytosis, whereas chronic exposure can produce aplastic anemia. Mark Dt Tran, MD is a member of the following medical societies: American Academy of Family PhysiciansDisclosure: Nothing to disclose. 5(5):270-6. [Medline]. 2006 Apr. Intermittent hemodialysis has been the treatment of choice when emergent extracorporeal lithium clearance is indicated, but postdialysis rebound elevations in lithium concentration with recurrent toxicity have been documented. Lithium is taken up avidly by thyroid cells and blocks thyroid hormone release from thyroglobulin, which inhibits adenylate cyclase and prevents thyroid-stimulating hormone (TSH) from activating thyroid cells via the TSH receptor. Farres MT, Ronco P, Saadoun D. Chronic lithium nephropathy: MR imaging for diagnosis. Some patients abnormally sensitive to Lithium may exhibit toxic signs at serum concentrations that are considered within the therapeutic range [see Boxed Warning, Dosage and Administration (2.3)]. 75(7):e672-8. 2001 Jun. [Medline]. 2009 Jun. Although accurate epidemiological data is not available, it is generally agreed that acute lithium toxicity is becoming a more frequent problem. Mark Dt Tran, MD Usually presents with gastrointestinal symptoms (ingested lithium acts directly as a gastrointestinal irritant). Lithium intoxication. If you log out, you will be required to enter your username and password the next time you visit. Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology, Southern Society for Clinical InvestigationDisclosure: Nothing to disclose. 2011 Jun. Myxedema coma has been reported as a complication of toxicity. Garofeanu CG, Weir M, Rosas-Arellano MP, et al. John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. Clin Toxicol (Phila). Renal function during long-term lithium treatment: a cross-sectional and longitudinal study. Use of sodium polystyrene sulfonate for reduction of plasma lithium concentrations after chronic lithium dosing in mice. BMC Med. Severe intoxication: Coma, seizures, hyperthermia, and hypotension (serum lithium concentration (less than 3.5 mEq/L). J Am Soc Nephrol. FDA Drug Approvals, Psychiatry — 2019 Midyear Review, Bipolar Depression in Adolescents and Young Adults: A Disorder of Mind and Body, Inflammatory Immune Findings Likely in Acute Schizophrenia, MDD, Bipolar, Billions of Years Old, Lithium Still Has a Promising Therapeutic Future, Seasonal Affective Disorder (SAD): Facts and Misconceptions, Time's Up Founder Choo Accused in Harassment Mishandling, COVID Positive After Two Vaccine Doses? Treatment of life-threatening lithium toxicity with high-volume continuous venovenous hemofiltration. [Medline]. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. [Medline]. Lee DC, Klachko MN. The higher your serum level, the likelier there will be both side effectsand the appearance of toxic symptoms (also ca… Lithium carbonate is widely used as a first-line therapeutic agent for the depressive and manic phases of bipolar disorder. [Medline]. Lithium was initially used to treat depression, gout, and neutropenia, and for cluster headache prophylaxis, but it … 36(4):309-13. Proc Assoc Am Physicians. [Medline]. Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy. These patients may display both GI and neurologic symptoms, and serum levels can be difficult to interpret. MR findings of lithium-related kidney disease: preliminary observations in four patients. Fotso Soh J, Torres-Platas SG, Beaulieu S, Mantere O, Platt R, Mucsi I, et al. Kidney Int. Lithium-induced NDI: acetazolamide reduces polyuria but does not improve urine concentrating ability. 51(4):243-8. Lithium Use, but Not Valproate Use, Is Associated With a Higher Risk of Chronic Kidney Disease in Older Adults With Mental Illness. Authors R T Timmer 1 , J M Sands. Lithium toxicity is usually caused by taking more than your prescribed dose of lithium, either at once or slowly over a long period of time. 2006 May. Abdom Imaging. J Toxicol Clin Toxicol. Markowitz GS, Radhakrishnan J, Kambham N, et al. Stone KA. Hong Kong Med J. Scott Med J. [Full Text]. John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System PharmacistsDisclosure: Nothing to disclose. 59(6):327-34. Gill J, Singh H, Nugent K. Acute lithium intoxication and neuroleptic malignant syndrome. J Am Board Fam Pract. Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. Lithium-induced reduction in urinary concentrating ability and urinary aquaporin 2 (AQP2) excretion in healthy volunteers. Vecihi Batuman, MD, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System Consequently recognition and treatment of lithium toxicity has also become more important. Progression of acute toxicity can involve neuromuscular signs such as tremulousness, dystonia, hyperreflexia, and ataxia. Nielsen J, Hoffert JD, Knepper MA, et al. Clos S, Rauchhaus P, Severn A, Cochrane L, Donnan PT. 1054-74. Lithium-induced nephrogenic diabetes insipidus: new clinical and experimental findings. Nielsen J, Kwon TH, Frokiaer J, et al. 2003. Neurological symptoms may occur several hours later, in a delayed fashion. Lithium was initially used to treat depression, gout, and neutropenia, and for cluster headache prophylaxis, but it fell out of favor because of its side effects. Long-term effect of lithium maintenance therapy on estimated glomerular filtration rate in patients with affective disorders: a population-based cohort study. Recent studies have also shown that it has the potential for the treatment of many other neurodegenerative disorders, including Alzheimer's, Parkinson's and Huntington's disease, through its neurotrophic, neuroprotective, antioxidant and anti-inflammatory … Mu J, Johansson M, Hansson GC, et al. Lithium as a mood stabilizer has been used as the standard pharmacological treatment for Bipolar Disorder (BD) for more than 60 years. 1998 Sep-Oct. 110(5):401-6. Lithium-induced nephrogenic diabetes insipidus. Lithium. Development of lithium-induced nephrogenic diabetes insipidus is dissociated from adenylyl cyclase activity. 2017 Sep 1. [Full Text]. Lithium has been used to treat bipolar disorder. J Clin Psychiatry. SIgns and symptoms are predominantly gastrointestinal (GI), including nausea, vomiting, cramping, and sometimes diarrhea. Proteomic analysis of lithium-induced nephrogenic diabetes insipidus: mechanisms for aquaporin 2 down-regulation and cellular proliferation. [Full Text]. 229:570-4. Acute poisoning These patients usually do not have a tissue body burden. [Medline]. 1999 Mar;10(3):666-74. Lancet Psychiatry. Urine osmolality, cyclic AMP and aquaporin-2 in urine of patients under lithium treatment in response to water loading followed by vasopressin administration. [Medline]. 2008. epub ahead of print:[Medline]. Cases have also been reported following bariatric surgery, which results in alteration of the pharmacokinetics of lithium. Causes of reversible nephrogenic diabetes insipidus: a systematic review. Long-term, low-dose lithium treatment does not impair renal function in the elderly: a 2-year randomized, placebo-controlled trial followed by single-blind extension. 2007 Jul 2. Altered expression of selected genes in kidney of rats with lithium-induced NDI. 2015 Aug 1. Although limb tremors and hypothyroidism are well-known side effects of lithium carbonate, other rare adverse reactions can also occur. Affiliation 1 Department of Physiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA. Acute-on-chronic The treatment of lithium nephrotoxicity depends on the severity of the toxicity and chronicity as well as the presence of related abnormalities. Risk factors for SILENT are age above 50 years, chronic lithium therapy, development of nephrogenic diabetes insipidus, hyperthyroidism, and impaired renal function. J Clin Psychiatry. Schou M. Forty years of lithium treatment. 2008 Mar 4. [Full Text]. [Full Text]. 2020 Jan. [Medline]. Rojek A, Nielsen J, Brooks HL, et al. The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS). American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, Southern Society for Clinical Investigation, American College of Clinical Pharmacology, Central Society for Clinical and Translational Research. Trepiccione F, Christensen BM. A l'équilibre, en l'absence de manifestations cliniques évoquant un dosage inadapté et de facteurs modifiant la clairance du lithium, un taux sérique trimestriel est suffisant.20 L'intervalle thérapeutique est compris entre 0,6-1,2 mmol/l, toutefois, des taux de 0,5-0,8 mmol/l diminuent le risque de toxicité et suffisent généralement à prévenir les rechutes chez les patient… 2018 Jul 16. [Medline]. [Full Text]. David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Clin Toxicol (Phila). 105(9):3634-9. Lithium is available in Australia as: Immediate-release lithium carbonate capsules – 250 mg tablets. Eur Psychiatry. Menghini VV, Albright RC Jr. George R Aronoff, MD Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine 1996. Anani S, Goldhaber G, Wasserstrum Y, Dagan A, Segal G. The 'SILENT Alarm': When History Taking Reveals a Potentially Fatal Toxicity. 2015 Jan 12. [Medline]. Once-daily regimens seem to be better tolerated than more-frequent (for example, twice-daily) dose regimens, but this finding has not been unanimously reported or prospectively tested. [6]. Patients should be treated according to their clinical manifestations. In the same year, however, the value of lithium in the treatment of acute mania was recognized. Aprahamian I, Santos FS, dos Santos B, Talib L, Diniz BS, Radanovic M, et al. Kidney Int. Chronic lithium toxicity is usually precipitated by introduction of a new medication that may impair kidney function/excretion or cause a hypovolemic state. [Medline]. Semin Nephrol. 2015 Jan 21. there are roughly three forms of lithium intoxication. National Poison Data System Annual Reports. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvMjQyNzcyLTExOTQ5NC9ob3ctaXMtbGl0aGl1bS1pbnRveGljYXRpb24tcHJldmVudGVk. Though the acute complications of lithium toxicity involving the central nervous system have been known for more than 70 years, it is only recently that the longlasting sequelae of lithium intoxication have come to be discussed at length; about fifty-five cases have been reported so far. [Medline]. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Goldfrank's Toxicologic Emergencies. Lithium Poisoning. 16 (4):199-206. BMC Psychiatry. This website also contains material copyrighted by 3rd parties. 1988. 1999 Jan-Feb. 12(1):43-7. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. A historical cohort study of kidney damage in long-term lithium patients: continued surveillance needed. [5, 7]. In the 1970s, Lithium carbonate was approved in the United States for the treatment of acute mania and bipolar disorder and it has been in use ever since. Some symptoms may last for a year after levels return to normal. [9] It may also affect thyroid hormone synthesis. Paw H, Slingo ME, Tinker M. Late onset nephrogenic diabetes insipidus following cessation of lithium therapy. 13:12. [Medline]. Lithium is a soft metal that can be helpful in the right doses and harmful if you take too much.3 One of the reasons doctors order periodic blood tests when you take lithium is because the window between an effective dose and a toxic dose is very small. 2008 May. 2015 Dec. 2 (12):1075-83. These patients usually do not have a tissue body burden. 2005 Jun. Decker BS, Goldfarb DS, Dargan PI, Friesen M, Gosselin S, Hoffman RS, et al. You are being redirected to
April 2019; DOI: 10.13140/RG.2.2.29753.21601 This website also contains material copyrighted by 3rd parties. [Medline]. Lithium has been used in medicine since the 1870s. [Medline]. Dysregulation of renal aquaporins and epithelial sodium channel in lithium-induced nephrogenic diabetes insipidus. 2009 May. [Full Text]. What a Nephrologist needs to know about Lithium intoxication. Major Subject Heading (s) Minor Subject Heading (s) [8]. [Medline]. George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, National Kidney FoundationDisclosure: Nothing to disclose. Mark S Slabinski, MD, FACEP, FAAEM Vice President, USACS Central Rej S, Segal M, Low NC, Mucsi I, Holcroft C, Shulman K, et al. Three main categories of lithium poisoning are as follows: acute, acute-on-chronic, and chronic. The most common endocrine disorder secondary to chronic toxicity is hypothyroidism. [Medline]. Jamison SC, Aheron K. Lithium toxicity following bariatric surgery. [Medline]. [Medline]. 2014 Jul. Nat Rev Nephrol. Atorvastatin in the treatment of Lithium-induced nephrogenic diabetes insipidus: the protocol of a randomized controlled trial. Lithium has a low therapeutic index; monitor levels closely to prevent acute lithium intoxication. Boton R, Gaviria M, Batlle DC. 313 (3):F669-F676. [Medline]. Gordon CE, Vantzelfde S, Francis JM. [Medline]. Hedya SA, Avula A, Swoboda HD. Drugs, 2001
2006 Aug. 12(4):254-9. 566(1-3):50-7. [Medline]. Anaesth Intensive Care. Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital Shine B, McKnight RF, Leaver L, Geddes JR. [Medline]. J Am Soc Nephrol. Nielsen J, Kwon TH, Christensen BM, et al. Accessed: October 26, 2020. Bailey AR, Sathianathan VJ, Chiew AL, Paterson AD, Chan BS, Arora S. Comparison of intermittent haemodialysis, prolonged intermittent renal replacement therapy and continuous renal replacement haemofiltration for lithium toxicity: a case report. Eur J Pharmacol. Robertson GL. 2017 May. Janowsky DS, Soares J, Hatch JP, et al. Lithium inhibits the action of antidiuretic hormone (ADH) on the distal renal tubule, impairing sodium and water reabsorption. Acetazolamide in Lithium-Induced Nephrogenic Diabetes Insipidus. [Medline]. 1997 Feb. 42(1):16-7. Anil Kumar Mandal, MD Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida College of Medicine [Medline]. [Medline]. Share cases and questions with Physicians on Medscape consult. Clifford C Dacso, MD, MPH, MBA is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of AmericaDisclosure: Nothing to disclose. 2014 Jun. Moderate-to-severe lithium toxicity is characterized by the following: Greller HA. Overview of Lithium Poisoning Lithium plasma concentrations greater than 1.2 mmol/L are potentially toxic and concentrations greater than 2.0 mmol/L can be fatal. Large ingestion in a previously lithium-naive patient. Lithium intoxication J Am Soc Nephrol. Am J Nephrol. What's a safe, effective dose for one person may be toxic to another. Bocchetta A, Ardau R, Fanni T, Sardu C, Piras D, Pani A, et al. Mental status is often altered and progression to coma and seizures may occur if the diagnosis is unrecognized. 2003 Jun. 2019 Dec. 57 (12):1220-1413. Lithium salts were first used as table salt substitutes in patients with hypertension or congestive heart failure, although the FDA withdrew them from the market in 1949 following the occurrence of acute, lethal, lithium intoxications.
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