MEDICATION-LITHIUM TOXICITY

SUMMARY

1. Lithium levels in the upper therapeutic range frequently cause tremor and asterixis.

2. Hyponatremia (and bendrofluazide) cause increased lithium resorption from the kidney.

3. Above a level of 1.5-2 mEq/L, the patient develops delirium, dizziness, vertical nystagmus or opsoclonus, diffuse myoclonus, ataxia, nephrogenic DI.

4. Opsoclonus: rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate eye movements.

5. Toxic lithium levels cause seizures and coma; treat with hemodialysis.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].