Lithium toxicity occurs when there are excessive levels of lithium in the blood. Symptoms range from mild like nausea and weakness to severe including seizures, coma and even death. Management involves stopping lithium intake, intravenous fluids to hydrate the patient, monitoring vital signs and blood lithium levels, and potentially interventions like dialysis. Nurses play an important role in monitoring patients on lithium therapy, educating them on signs of toxicity, and ensuring safe lithium levels through regular blood tests.

2. MANAGEMENT OF LITHIUM
TOXICITY
PRESENTED BY,
SUBARNA NEOGI
M.SC NURSING 1ST YEAR
C.O.N., JIPMER

3. HISTORY:
• In 1800s, lithia water first introduced as MANIA & GOUT
treatment.
• But after having a higher concentration it is found to be
associated with tremors and weakness.
• First “lithium toxicity” is described in 1898

4. Invention of lithium:
• Discovered by Swedish Chemist
JOHAN ARFREDSON in 1817
• It is element no 3 in periodic table-
A soft silvery metal.
• It is used as a salts including lithium
carbonate, citrate & lithium orotate.

5. ORIGIN OF LITHIUM:
• Name originated from “LITHOS” means stone.
• It was discovered from a mineral.
• Use of lithium salt came from spring and spas of North Italy.
People used to drink water for soothing effect.
• Use of lithium salts in Mania 1st by an Australian doctor in
1949.

6. ETIOLOGY OF LITHIUM TOXICITY:

7. PHARMACODYNAMICS:
• Producing brain inositol depletion, leading to reduced responsiveness
to alpha-adrenergic stimulation.
• Reducing neuronal responsiveness to neurotransmitters due to
inhibitory effect on adenylate cyclase & G protein.
• Stimulating serotonin release from hippocampus.
• Being a cation, it also effects in ion transport and cell membrane
potential.

8. TYPES OF LITHIUM TOXICITY:

9. PATHOPHYSIOLOGY:
EXCESSIVE INTAKE
IMPAIRED EXCRETION
TOXICOKINESIS

10. TOXICOKINESIS:
• Its absorption is rapid.
• It is neither metabolised nor protein bound,
• Serum lithium level reflects only the extracellular lithium
concentration
• It accumulates mostly in liver, bone, muscles, thyroid gland affecting
the brain & kidney.
• Volume depletion can leads to elevate lithium level in blood.
• Half life is 12- 27 hours, it can be up to 48 hours.
• It can cross placenta and can excreted through breast milk
• Renal clearance is usually 10-40ml/min.

12. SIGN & SYMPTOMS:
MILD TO MODERATE TOXICITY:
Diarrhoea
Vomiting
Stomach pain
Fatigue
Uncontrollable movements
Muscle weakness, twitching, tremors
Drowsiness
Lack of appetite

13. CONTED……
SEVERE TOXICITY:
Heightened reflexes
Seizure
Agitation
Kidney failure
Slurred speech
Hyperthermia
Low BP, Rapid heartbeat
Uncontrollable eye movements
Coma, confusion
Delirium, death

14. DIAGNOSIS:
• An ECG
• A blood chemistry test-
To determine the metabolism and
electrolyte level
• Blood & urine test-
To determine serum lithium level
• A blood test to assess kidney
function

15. MANAGEMENT OF LITHIUM TOXICITY:
IN MODERATE TOXICITY:
Stomach pumping
Whole bowel irrigation
IV fluids administration
Haemodialysis
Medication
Vital sign monitoring
Not to follow home remedies like activated
charcoal, which does not even bind with
lithium

16. CONTD……
IN SEVERE CASES
Administer osmotic diuretics
Alkaline the urine with IV Nacl & sodium
lactate
Adequate intake of Nacl
Haemodialysis when there is anuria & CNS
Depression
Mobilize the patient after discharge
Frequent clinical visits & check blood lithium
levels.
Assess for depression & suicidal intent.

17. TREATMENT:
DECONTAMI
NATION
ELIMINATION

18. MANAGEMENT OF LITHIUM
TOXICITY:
Assess quickly
Withhold lithium doses
Immediate hospitalization
Check vital sign & LOC.
Be prepare with stabilization
procedure, protect airway &
supplemental oxygen,
Obtain blood lithium level,
electrolyte, BUN, Creatinine,
urine analysis, CBC.
ECG, Cardiac status
monitoring.
Vigorously hydrate patient
with 5-6lit/day along with
electrolyte
Provide NG Suctioning
Patient will be bedridden
ROM, Pulmonary toileting
NURSES RESPONSIBILITY IN
PREVENTION:
 Obtain complete history.
 Assess mental, emotional
status.
 Monitor fluid & electrolyte
balance.
 Maintain I & o chart.
 Weigh the client daily.
 Monitor renal status, CBC,
BUN, creatinine, uric acid
 Monitor GI Status
(dyspepsia, diarrhoea)
 Monitor metabolic status, it
may cause goitre & false
positive result on thyroid
test.
 Monitor cardiovascular
status, vital sign & apical
pulse.
BLOOD TESTING:
Routine blood test at every
¾ th in a month
Medical personnel must be
trained to monitor lithium
level.
Sample to be taken at least
after 12 hours of last lithium
dose.
To keep always signed blood
request forms.
BIBLIOGRAPHY:
1. Marry townsent. Textbook of Psychiatric
nursing. Wolterklevier. Davis Publication.
2. https:// www.scribd.com/document/
279274978/lithium toxicity.

19. ENHANCING HEALTH CARE TEAM OUTCOME:
• Check serum lithium levels regularly
• Make them aware about the signs of lithium toxicity
• Aware the patient about contraceptive treatment of lithium
• If any sign appears to stop medicine & seek medical help
• Extra care should be taken if any activity, illness or medicine might
precipitate profound loss of water
• Lithium treatment card to be carried always