Lithium Toxicity

A patient can become lithium-toxic while taking every prescribed dose. Diarrhea, fever, poor intake, a new NSAID, or declining renal function may reduce lithium clearance enough to cause poisoning. A new coarse tremor, ataxia, confusion, or myoclonus is a neurologic warning: withhold lithium and notify the prescriber immediately, even when the reported concentration is near the treatment range. Lithium toxicity is a clinical syndrome supported by serial laboratory data. Withhold lithium when toxicity is suspected, support airway, breathing, and circulation, restore circulating volume with prescribed isotonic IV fluid when indicated, identify the cause of reduced clearance, and obtain urgent poison-centre or clinical toxicology guidance. For seizure, declining consciousness, a life-threatening dysrhythmia, hypotension, or markedly reduced urine output, activate the rapid response or code team immediately in hospital or call 911 immediately in the community, then notify the responsible physician or NP immediately.