Can cause permanent neurologic sequelae (tremor ataxia)
4 Clinical manifestationsof Lithium toxicity
Mild (1.5-2.5) to Moderate (2.5-3.5) neuromuscular excitabilty with twitching fine tremor motor agitation ataxia muscular weakness delirium N/V diarrhea
Severe (gt3.5) seizures stupor coma
Labs leukocytosis electrolyte disturbance reduced anion gap
Fluid repletion is essential
Monitor sodium in pts who may have underlying DI
Diuretics not useful FELI does not change consistently
Hemodialysis the most dialyzable toxin known. Vd similar to that of water.
Rebound effect may occur intracellular Li diffuses out or there is continued absorption from GI tract.
6 Indications to Dialyze
Plasma Li above 4
Plasma Li above 2.5 in a pt who is markedly symptomatic or has ongoing condition that limits urinary excretion
Li level 2.5-4.0 in an asymptomatic pt who cannot reduce to lt0.6 within 36 hours. Can plot 3 or more Li at 2 hour intervals on a log-linear scale vs. time.
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