Lithium is a mood stabilizing medication used primarily for treating bipolar disorder, with a narrow therapeutic range that necessitates careful monitoring to prevent toxicity. Symptoms of lithium toxicity can range from generalized effects like nausea and dizziness to severe outcomes such as seizures and kidney failure, with both acute and chronic forms dependent on dosage and duration of use. Management includes life stabilization, symptomatic treatment, and potential interventions like hemodialysis for severe cases.

1. LITHIUM TOXICITY
Nabina Paneru

2. Introduction
Lithium
◈ Lithium is a chemical substances used as mood stabilizing drugs.
◈ It has narrow therapeutic range, so it is used along with
benzodiazepines, antipsychotic drugs and antiepileptic drugs to
reduce hyperactivity.
◈ Lithium carbonate is used as a drug of choice.
◈ It is mainly available in the form of tablet, capsule, solution.

3. Mechanism of action
◈ Lithium alters sodium metabolism within nerve and muscle
cells and enhances the reuptake of biogenic amines
(norepinephrine and serotonin) in the brain, lowering levels
in the body and resulting in decreased hyperactivity.
◈ It may block development of sensitive dopamine receptors in
the CNS of manic patient. Lithium has both antimanic and
antidepressant properties.

4. Indication
◈ Is used in prevention and treatment of manic
episodes associated with bipolar disorder.
◈ As mood stabilizer lithium reduces the risk of
suicide in people with bipolar disorder.

5. Contraindications
◈ Individuals with hypersensitivity to the
drugs
◈ Severe cardiovascular and renal disease
◈ Severe dehydration
◈ Brain damage
◈ Pregnancy and lactation

6. Lithium toxicity
If serum lithium exceeds 1.5-2.5 meq/lit then lithium
toxicity occurs. There is narrow margin between
therapeutic and toxic level of lithium carbonate.
◈ The usual ranges of therapeutic serum
concentrations are:
◈ For acute mania: 1 to 1.5 meq/l
◈ Long term:0.6-1.2 meq/l

7. Types of lithium toxicity
Acute toxicity
When lithium is swallowed intentionally or
accidentally in higher amount
Chronic toxicity
When lithium is taken a little to much of lithium
prescription everyday

8. Signs and symptoms
◈ Generalized symptoms
◈ Diarrhea
◈ Nausea
◈ Dizziness
◈ Stomach pain
◈ Weakness
◈ Dry mouth
◈ Polyuria ;dehydration
◈ Specific symptoms
◈ Hand tremors
◈ Incoordination of arms and
limbs
◈ Muscle twitches
◈ Seizures
◈ Slurred speech
◈ Nystagmus

9. Chronic symptoms
•Slurred speech
•Tremors
•Increased reflexes
•Kidney failure
•Memory problems
•Movement disorder
•Psychosis

10. Aggravating factors
◈ Thiazide diuretics
◈ ACE inhibitors
◈ Calcium channel blockers
◈ NSAIDS

11. Management
◈ Pre – hospital care
 Stabilize life threatening conditions and initiate supportive
therapy
 Obtain intravenous access with isotonic sodium chloride
solution and administer O2
 Monitor cardiac function to assess rhythm disturbances
 Obtain all pill bottles available to the patient

12. Contd.
◈ Emergency department care
 GI decontamination:
- Gastric Lavage (within 1 hr of ingestion)
- Bowel irrigation with polyethylene glycol
- Use of sodium polystyrene sulfonate
 Enhanced elimination
- NS ( to restore GFR, normalize urine output)
- Hemodialysis (for those with renal failure, CHF or liver disease and
lithium level 4mEq/L in acute toxicity and level of 2.5mEq/L in chronic
toxicity in pts with symptoms)

13. Contd.
◈ Consultations
 Consult renal service personnel for hemodialysis
in severe toxications
 Consult psychiatric service personnel for
patients with intentional overdose
 Consult the poison control centre and a medical
toxicologist regarding appropriate treatment

14. NURSING CONSIDERATIONS
 Serum lithium level should be monitered once or twice a week
after initial treatment until doses and serum level are stable
 Blood sample should be drawn 12 hours after the last dose
As per the symptoms
◈ Drowsiness, dizziness, headache
 It should be ensured that the patient does not participate in
activities that required alertness until the respose has stabilized

15. Contd.
◈ Dry mouth,thirst
 Patient should be provided with sugarless
candy,ice,frequent sips of water
 Strict oral hygiene should be maintained
◈ GI upset, nausea ,vomiting
 Doses should be scheduled with meals to
minimize GI upset

16. Contd.
◈ Hand tremors
 Physician should be informed who may prescribe small
dose of beta blocker propanolol to counteract the
sideeffect
◈ Polyuria, dehydration
 Daily intake and output should be monitered along with
skin turgor

17. Contd.
◈ Weight gain
 Reduced calorie diet should be instructed
 Importance of maintaining adequate intake of
sodium.