Lithium toxicity can be acute or chronic in nature. Acute lithium toxicity primarily affects the gastrointestinal system followed by the central nervous system. The various signs and symptoms of acute as well as chronic lithium toxicity have been described below:
Acute lithium toxicity
Chronic lithium toxicity
Blood and urine analysis should reveal elevated levels of lithium. The sample should be sent in lithium free tubes as false elevated levels of lithium have been reported in the past due to collection of sample in tubes containing lithium. Renal function tests should be done to assess the functioning of kidneys and its ability to filter off the lithium from the body. Initial electrocardiographic examination of patients with lithium toxicity may show signs of increased QT intervals and T wave inversion . Imaging studies such as CT scan of the head will be required to rule out other associated secondary conditions.
The primary goal of the treatment would be to stabilize the patient’s condition and make immediate arrangement to remove any pills before they are absorbed by the gastrointestinal system. This is done through gastric lavage and is the treatment of choice only when the toxicity has occurred due to swallowing of large number of pills containing lithium. Dialysis will be required to remove out excess of lithium from the body . Recent researches have determined that sodium polystyrene sulfonate as a cation exchanger has successfully removed lithium from both human and animal subjects making it a promising cure . Intestinal irrigation and forced diuresis may also be implored to reduce absorption of lithium in the system during toxicity . Medications are given to effectively manage the symptoms.
Individuals who receive prompt medical help and do not present with symptoms of deteriorated functioning of the nervous system often have a good prognosis. Those, who have taken larger doses of lithium and present with disorders of the nervous system, may suffer from debilitating symptoms for the rest of the life . If dialysis is carried out immediately, other symptoms may resolve; but symptoms of nervous system may stay on for remaining part of their life. In chronic toxicity, diagnosis sometimes is delayed which can give rise to development of secondary complications. Chronic toxicity slowly and gradually harms the system causing irreversible damages that do not get corrected even with rigorous treatment regime. Elderly patients with lithium toxicity has a worse prognosis .
In severe cases, lithium toxicity may call for development of the following complications:
Accidental or intentional consumption of excess lithium is the major cause of toxicity. Individuals may tend to take extra dosage for several days together or may intentionally take a large dose together. Such an activity can lead to life threatening complications if prompt treatment is not initiated. Patients with other medications that causes the lithium to accumulate in the serum has been implicated as major source of lithium toxicity . As per the guidelines given by FDA, consumption of more than 1.2 mEq/L of lithium can lead to its toxicity.
It has been estimated that cases of lithium toxicity occurs in about 10,000 individuals per year. Statistical data also point towards the fact that, about 2000 individuals in the US suffer from moderate to severe mortality due to lithium toxicity. An estimated 10% population below the age of 19 years is known to be affected by lithium toxicity.
With lithium toxicity, the organs affected are the central nervous system, followed by the renal system , gastrointestinal and the endocrine system. Patients with renal diseases should be closely monitored for lithium dosages because the drug is filtered from the body through the kidneys. Serum levels at 15mg/L may cause some confusion and speech impairment, while levels beyond 20mg/L may have risks for death . The half-life of lithium is known to be 12 to 27 hours; however for the elderly population, the half-life increases to 32 hours.
The best way to prevent lithium toxicity if it was not intentional is to watch the dosage schedule before ingesting any pills. It is also recommended that patients with bipolar disorder should not be tempted to take any extra dose without the doctor’s consent. If symptoms of bipolar disorder tend to get worse then individuals are advised to seek medical help and not take any extra medications without consulting the doctor.
Ingestion of excess amount of lithium either accidentally or intentionally can lead to lithium toxicity. Lithium is a soft metal that is used for treating bipolar disorder. In the past this metal was meant for treating depression, gout and cluster headache. However, the use of this drug was discontinued due to its various side effects. Later on, the drug was found to have calming effects which proved to be beneficial for patients with bipolar disorder . When an individual consumes more than the recommended dosage of lithium either together or slowly over a period of several days then lithium toxicity sets in.
Definition: Lithium toxicity is defined as ingestion of over 1.2mEq/L of lithium. The toxicity can either be intended or accidental. Intended toxicity occurs when individuals knowingly consume large doses of lithium to harm themselves. Accidental toxicity occurs as a result of consumption of more than prescribed dosage of medications.
Cause: Consumption of more than the recommended doses of lithium causes its toxicity. Lithium is prescribed for treatment of bipolar disorder. Patients can accidentally consume more doses and end up developing toxicity. Or certain individuals may deliberately ingest large doses of lithium causing toxicity.
Symptoms: Preliminary signs of acute lithium toxicity include nausea, diarrhea, vomiting, abdominal pain and seizures. In more severe cases, patients may experience kidney failure, coma, mood disorders, and damage to the central nervous system, tremors, increased reflexes and slurred speech.
Diagnosis: Diagnosis of the condition begins with a blood and urine test to determine the levels of lithium ingested. The blood sample needs to be collected in lithium free tubes to avoid false results. In addition, CT scan of the brain would also be required to rule out other disease conditions. Renal functions tests should be done to assess the kidney functioning.
Treatment: Preliminary gastric lavage may be carried out to eliminate the excess lithium pills before they are absorbed into the system. Following this, if the kidneys are affected dialysis may be required to aid the organ in eliminating the lithium from the body. In addition, medications would also be administered to stabilize the condition of patients.