Lithium toxicity
Definition
Lithium is a prescription medicine used to treat bipolar disorder. This article focuses on lithium overdose, or toxicity.
- Acute toxicity occurs when you swallow too much of a lithium prescription at one time.
- Chronic toxicity occurs when you slowly take a little too much of a lithium prescription every day for a while. This is quite easy to do, because dehydration, other medicines, and other conditions can easily affect how your body handles lithium. These factors can make the lithium build up to harmful levels in your body without you intending this.
- Acute-on-chronic toxicity occurs when you normally take lithium every day, but one day you take an extra amount. This can be as little as a couple of pills or as much as a whole bottle.
Lithium is a medicine with a narrow range of safety. Significant poisoning can result when the amount of lithium taken is more than this range.
This article is for information only. DO NOT use it to treat or manage an actual overdose or toxicity. If you or someone you are with has an overdose or toxicity, call your local emergency number (such as 911), or your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.
Alternative Names
Lithobid toxicity
Poisonous Ingredient
Lithium is a medicine that can be harmful in large amounts.
Where Found
Lithium is sold under various brand names, including:
- Carbolith
- Lithobid
Note: Lithium is also commonly found in batteries, lubricants, high performance metal alloys, and soldering supplies. This article focuses only on the medicine form of lithium. Small amounts of lithium are also found in certain spring waters.
Symptoms
Symptoms of the three types of lithium toxicity are described below.
ACUTE TOXICITY
Common symptoms of taking too much lithium at one time include the following symptom groups.
Stomach and intestinal symptoms:
- Nausea
- Vomiting
- Diarrhea
- Stomach pains
Neurologic symptoms (develop after the intestinal symptoms)
- Dizziness
- Weakness
- Coma (decreased level of consciousness, lack of responsiveness)
- Hand tremors
- Lack of coordination of arms and legs
- Muscle twitches
- Seizures
- Slurred speech
- Uncontrollable eye movement
- Changes in mental status or altered thinking
Heart problems may occur in rare cases:
- Slow heart rate
CHRONIC TOXICITY
There will likely not be any stomach or intestinal symptoms. Symptoms that can occur include:
- Increased reflexes
- Slurred speech
- Uncontrolled shaking (tremors)
In severe cases of chronic toxicity, there may also be nervous system and kidney problems, such as:
- Kidney failure
- Drinking a lot of fluids
- Urinating more or less than normal
- Memory problems
- Movement disorders, muscle twitches, hand tremors
- Problems keeping salts in your body
- Psychosis (disturbed thought processes, unpredictable behavior)
- Coma (decreased level of consciousness, lack of responsiveness)
- Lack of coordination of arms and legs
- Seizures
- Slurred speech
ACUTE-ON-CHRONIC TOXICITY
There will often be a combination of the acute and chronic symptoms listed above, including both nervous system and intestinal symptoms.
Before Calling Emergency
Determine the following:
- Person's age, weight, and condition
- Name of the product (ingredients and strength, if known)
- Time it was swallowed
- Amount swallowed
- Whether the medicine was prescribed for the person
Poison Control
Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
What to Expect at the Emergency Room
Take the container to the hospital with you, if possible.
The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.
Tests that may be done include:
- Blood tests to measure lithium levels and other body chemicals, and urine tests to detect other drugs
- Electrocardiogram (ECG)
- Pregnancy test in younger women
- CT scan of the brain in some cases
Treatment may include:
- Fluids through a vein (by IV)
- Medicines to treat symptoms
- Activated charcoal, if other substances were also taken
- Laxative
- Whole bowel irrigation with a special solution taken by mouth or through a tube through the nose into the stomach (to flush sustained-release lithium quickly through the stomach and intestines)
- Kidney dialysis (kidney machine)
Outlook (Prognosis)
If someone has acute lithium toxicity, how well they do depends on how much lithium they took and how quickly they get help. People who do not develop nervous system symptoms usually do not have long-term complications. If serious nervous system symptoms occur, these problems may be permanent.
Chronic toxicity is sometimes hard to diagnose at first. This delay can lead to long-term problems. If dialysis is done quickly, the person may feel much better. But symptoms such as memory and mood problems may be permanent.
Acute-on-chronic overdose often has a poor outlook. Nervous system symptoms may not go away, even after treatment with dialysis.
References
Aronson JK. Lithium. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:597-660.
Soderstrom J. Lithium. In: Cameron P, Little M, Mitra B, Deasy C, eds. Textbook of Adult Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 25.5.
Theobald JL, Aks SE. Lithium. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 154.
Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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