Recognition and treatment of lithium poisoning: a literature review

Viktorija Antonova-Šiaudvytė1

1Vilniaus universitetas, Medicinos fakultetas, Vilnius, Lietuva


Introduction. Lithium is prescribed to treat mental disorders. Excessive intake and impaired excretion increase lithium levels. Poisoning can be mild, moderate and severe. Symptoms include neurological, gastrointestinal, cardiac, renal and endocrine dysfunction. Neurological symptoms and high serum levels indicate discontinuation of lithium, fluid infusion and hemodialysis. Because of the life-threatening effects it is important to know the clinical presentation for diagnosis and appropriate treatment.

Aim: to review the aetiology, clinical features, diagnosis and treatment of lithium poisoning as described in the scientific literature.

Methods. The international database PubMed was used for literature review. 30 articles were selected using the following keywords or a combination of keywords: lithium, toxicity, clinical features, treatment. More than 60 English-language articles were analysed between 1995-2022. The most relevant and publishable scientific articles were selected.

Results. Acute poisoning is characterised by milder symptoms. Discontinuation of lithium and neurological signs monitoring is recommended. Acute-chronic poisoning occurs with more severe symptoms. Chronic poisoning occurs when renal function is impaired. Symptoms depend on lithium levels, duration of intoxication and individual tolerance. Symptoms include neurological, gastrointestinal, cardiac, renal and endocrine dysfunction. In more severe cases, fluid infusion, gastric lavage, intestinal irrigation and hemodialysis are recommended. In cases of renal impairment, hemodialysis is used regardless of serum lithium levels.

Conclusions. Poisoning is manifested by disorders of various organs. In acute cases, lithium administration is discontinued and clinical signs are observed. In acute-chronic and chronic cases serum lithium concentrations are monitored, hemodialysis is used.

Keywords: lithium, lithium toxicity, poisoning.

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