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Key Features

  • Occurs at serum lithium levels > 2 mEq/L

  • Sodium loss (from diarrhea, diuretics, perspiration) results in elevated lithium levels

  • Toxicity is more severe in the elderly

Clinical Findings

  • Diarrhea, vomiting

  • Tremors, marked weakness, confusion

  • Dysarthria, ataxia, vertigo, choreoathetosis, hyperreflexia

  • Rigidity, lack of coordination

  • Myoclonus, seizures, opisthotonos, coma

Diagnosis

  • Serum lithium levels confirm the diagnosis

Treatment

  • Induced emesis and gastric lavage for massive ingestions or levels > 2.5 mEq/L

  • Osmotic or saline diuresis in patients with normal renal function

  • Urinary alkalinization with sodium bicarbonate or acetazolamide

  • Aminophylline potentiates the diuretic effect by increasing the clearance of lithium

  • Hemodialysis should be considered when blood lithium levels are > 2.5 mEq/L

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