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Management of lithium intoxication

Research output: Contribution to journalArticlepeer-review

Niamh Murphy, Lynn Redahan, John Lally

Original languageEnglish
JournalBJPsych Advances
Early online date28 Feb 2022
DOIs
Accepted/In press1 Feb 2022
E-pub ahead of print28 Feb 2022

Bibliographical note

Publisher Copyright: © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

King's Authors

Abstract

SUMMARY Lithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.

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