REBEL Core Cast 93.0 – Lithium Toxicity

Marco Torres on 01/11/2023

Take Home Points

Lithium toxicity comes in a three flavors: acute, chronic and acute on chronic. Each form will have a different presentation as well as management.
Lithium levels are often unreliable in terms of guiding management and must be taken in context with symptoms and time of ingestion (in acute overdose).
IV fluids are a cornerstone of management as increasing intravascular volume and increasing renal elimination are critical.
Hemodialysis is indicated for a lithium level > 5 mEq/L or a level > 4 mEq/L in a patient with renal failure. However, dialysis decisions should be made in conjunction with a toxicologist.

Take Home Points

Lithium toxicity comes in a three flavors: acute, chronic and acute on chronic. Each form will have a different presentation as well as management.
Lithium levels are often unreliable in terms of guiding management and must be taken in context with symptoms and time of ingestion (in acute overdose).
IV fluids are a cornerstone of management as increasing intravascular volume and increasing renal elimination are critical.
Hemodialysis is indicated for a lithium level > 5 mEq/L or a level > 4 mEq/L in a patient with renal failure. However, dialysis decisions should be made in conjunction with a toxicologist.