Lithium toxicity

Definition

Lithium is a prescription medicine used to treat bipolar disorder. This article focuses on lithium overdose, or toxicity.

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:

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:

Neurologic symptoms (develop after the intestinal symptoms)

Heart problems may occur in rare cases:

CHRONIC TOXICITY

There will likely not be any stomach or intestinal symptoms. Symptoms that can occur include:

In severe cases of chronic toxicity, there may also be nervous system and kidney problems, such as:

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:

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:

Treatment may include:

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.



Review Date: 11/2/2023
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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