Please enter verification code
Lithium Poisoning Update in Diagnosis and Treatment
American Journal of Internal Medicine
Volume 8, Issue 5, September 2020, Pages: 215-220
Received: Jul. 25, 2020; Accepted: Aug. 6, 2020; Published: Aug. 20, 2020
Views 165      Downloads 118
Jorge Rico-Fontalvo, Department of Nephrology, Soma Clinic, Medellín,
Rodrigo Daza-Arnedo, Department of Nephrology, New Bocagrande Hospital, Cartagena, Colombia
Victor Leal-Martínez, Department of Internal Medicine, New Bocagrande Hospital, Cartagena, Colombia
Emilio Abuabara-Franco, Department of Internal Medicine, Estrios Clinic, Cartagena, Colombia
Nehomar Pájaro-Galvis, Department of Internal Medicine, University of Sinu, Cartagena, Colombia
José Correa-Guerrero, Department of Critical Medicine and Intensive Care, University of Cartagena, Cartagena, Colombia
Maria Raad-Sarabia, Department of Internal Medicine, University of Sinu, Cartagena, Colombia
Alonso Pomares-Lara, Department of Internal Medicine, San Jose de Torices Clinic, Cartagena, Colombia
Dayana Ayola-Rosales, Department of Medicine, University of Sinu, Cartagena, Colombia
Karen Mercado-Anillo, Department of Medicine, University of Cartagena, Cartagena, Colombia
Yamile Sepúlveda-Hernandez, Department de Medicine, San Jose de Torices Clinic, Cartagena, Colombia
Huber Alvarado-Castell, Department of Medicine, Blas de Lezo Clinic, Cartagena, Colombia
Christian Pérez-Calvo, Department of Medicine, Blas de Lezo Clinic, Cartagena, Colombia
Article Tools
Follow on us
Introduction: Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, however, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise. As of today, there is no specific antidote for lithium, so intermittent hemodialysis is the strategy of choice for the intoxicated patient. Objectives: To describe the available and relevant literature on the management of Lithium poisoning. Methodology: A search was performed with the MeSH terms "Lithium, Renal Dialysis, Poisoning, Toxicity, Acute kidney injury" in the ClinicalKey, PubMed and Ovid databases search engines, finding 156 results, of which 47 were used to develop this manuscript. Conclusions: Lithium poisoning is frequent due to its narrow therapeutic margin, so serum lithium levels should be monitored in patients medicated with it. Today there is no specific antidote, so renal replacement therapy is the best therapeutic option for lithium poisoning, demonstrating high efficiency, especially in cases of marked neurotoxicity. It is necessary to assess the need to initiate timely management in order to achieve a rapid clearance of the drug and decrease the rate of complications and mortality.
Lithium, Renal Dialysis, Poisoning, Toxicity, Acute Kidney Injury (MeSH)
To cite this article
Jorge Rico-Fontalvo, Rodrigo Daza-Arnedo, Victor Leal-Martínez, Emilio Abuabara-Franco, Nehomar Pájaro-Galvis, José Correa-Guerrero, Maria Raad-Sarabia, Alonso Pomares-Lara, Dayana Ayola-Rosales, Karen Mercado-Anillo, Yamile Sepúlveda-Hernandez, Huber Alvarado-Castell, Christian Pérez-Calvo, Lithium Poisoning Update in Diagnosis and Treatment, American Journal of Internal Medicine. Vol. 8, No. 5, 2020, pp. 215-220. doi: 10.11648/j.ajim.20200805.14
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
J. E. Rico Fontalvo, “Intoxicación por litio, una verdadera urgencia dialítica,” Rev. Colomb. Nefrol., 2018.
M. D. Okusa and L. J. T. Crystal, “Clinical manifestations and management of acute lithium intoxication,” The American Journal of Medicine. 1994.
J. F. Aita, J. A. Aita, and V. A. Aita, “7-Up anti-acid lithiated lemon soda or early medicinal use of lithium.” Nebr. Med. J., 1990.
B. Corbella and E. Vieta, “Molecular targets of lithium action,” Acta Neuropsychiatrica. 2003.
K. Ware, E. Tillery, and L. Linder, “General pharmacokinetic/pharmacodynamic concepts of mood stabilizers in the treatment of bipolar disorder,” Ment. Heal. Clin., vol. 6, no. 1, pp. 54–61, 2016.
K. Sanborn and J. W. Jefferson, “Everyman’s guide to the fluctuating lithium level. Obvious and obscure reasons why serum lithium levels change,” Annals of Clinical Psychiatry. 1991.
S. A. Hedya and H. D. Swoboda, Toxicity, Lithium. 2018.
E. Jakobsson et al., “Towards a Unified Understanding of Lithium Action in Basic Biology and its Significance for Applied Biology,” Journal of Membrane Biology. 2017.
G. S. Sachs, D. J. Printz, D. A. Kahn, D. Carpenter, and J. P. Docherty, “The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000.,” in Postgraduate medicine, 2000.
S. S. Burgess et al., “Lithium for maintenance treatment of mood disorders,” Cochrane Database Syst. Rev., 2001.
E. Grandjean and J. Aubry, “Lithium: Updated Human Knowledge Using an Evidence-Based Approach: Part II: Clinical Pharmacology and Therapeutic Monitoring.,” CNS Drugs, 2009.
S. C. Chien, K. T. Liu, and Y. H. Wu, “Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report,” Med. (United States), 2018.
R. Haussmann, M. Bauer, S. von Bonin, P. Grof, and U. Lewitzka, “Treatment of lithium intoxication: facing the need for evidence,” International Journal of Bipolar Disorders. 2015.
P. R. Finley, “Drug Interactions with Lithium: An Update,” Clinical Pharmacokinetics. 2016.
W. S. Waring, W. J. Laing, A. M. Good, and D. N. Bateman, “Pattern of lithium exposure predicts poisoning severity: Evaluation of referrals to a regional poisons unit,” QJM, 2007.
F. Canan, A. Kaya, S. Bulur, E. S. Albayrak, S. Ordu, and A. Ataoglu, “Lithium intoxication related multiple temporary ecg changes: A case report,” Cases J., 2008.
M. Ott, B. Stegmayr, E. Salander Renberg, and U. Werneke, “Lithium intoxication: Incidence, clinical course and renal function - A population-based retrospective cohort study,” J. Psychopharmacol., 2016.
J. Davis, M. Desmond, and M. Berk, “Lithium and nephrotoxicity: A literature review of approaches to clinical management and risk stratification,” BMC Nephrol., 2018.
R. N. M. Maddala, A. J. Ashwal, M. S. Rao, and R. Padmakumar, “Chronic lithium intoxication: Varying electrocardiogram manifestations,” Indian J. Pharmacol., 2017.
D. Kibirige, K. Luzinda, and R. Ssekitoleko, “Spectrum of lithium induced thyroid abnormalities: A current perspective,” Thyroid Research. 2013.
R. Gong, P. Wang, and L. Dworkin, “What we need to know about the effect of lithium on the kidney,” Am. J. Physiol. - Ren. Physiol., 2016.
R. T. Timmer and J. M. Sands, “Lithium intoxication,” J. Am. Soc. Nephrol., 1999.
P. Grof and E. Grof, “Varieties of lithium benefit,” Prog. Neuropsychopharmacol. Biol. Psychiatry, 1990.
E. Calabrese, “Hormesis: a revolution in toxicology, risk assessment and medicine: Re-framing the dose–response relationship,” EMBO Rep., 2004.
B. M. Christensen et al., “αENaC-mediated lithium absorption promotes nephrogenic diabetes insipidus,” J. Am. Soc. Nephrol., 2011.
M. L. A. Kortenoeven et al., “Amiloride blocks lithium entry through the sodium channel thereby attenuating the resultant nephrogenic diabetes insipidus,” Kidney Int., 2009.
R. Rao et al., “Lithium treatment inhibits renal GSK-3 activity and promotes cyclooxygenase 2-dependent polyuria,” Am. J. Physiol. - Ren. Physiol., 2005.
E. Mohandas and V. Rajmohan, “Lithium use in special populations,” Indian J. Psychiatry, 2007.
J. P. Grünfeld and B. C. Rossier, “Lithium nephrotoxicity revisited,” Nature Reviews Nephrology. 2009.
Y. Wang et al., “Inhibiting glycogen synthase kinase-3 reduces endotoxaemic acute renal failure by down-regulating inflammation and renal cell apoptosis,” Br. J. Pharmacol., 2009.
H. Bao et al., “Delayed administration of a single dose of lithium promotes recovery from AKI,” J. Am. Soc. Nephrol., 2014.
R. Oruch, M. A. Elderbi, H. A. Khattab, I. F. Pryme, and A. Lund, “Lithium: A review of pharmacology, clinical uses, and toxicity,” European Journal of Pharmacology. 2014.
D. Vodovar, S. El Balkhi, E. Curis, N. Deye, and B. Mégarbane, “Lithium poisoning in the intensive care unit: predictive factors of severity and indications for extracorporeal toxin removal to improve outcome,” Clin. Toxicol., 2016.
J. Baird-Gunning, T. Lea-Henry, L. C. G. Hoegberg, S. Gosselin, and D. M. Roberts, “Lithium Poisoning,” Journal of Intensive Care Medicine. 2017.
D. M. Roberts and S. Gosselin, “Variability in the Management of Lithium Poisoning,” Semin. Dial., 2014.
F. Eyer et al., “Lithium poisoning: Pharmacokinetics and clearance during different therapeutic measures,” J. Clin. Psychopharmacol., 2006.
M. Bretaudeau Deguigne, J. F. Hamel, D. Boels, and P. Harry, “Lithium poisoning: The value of early digestive tract decontamination,” Clin. Toxicol., 2013.
R. Thanacoody et al., “Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients,” Clinical Toxicology. 2015.
D. Vodovar, L. Minh P., L. Labat, and B. Mégarbane, “Identifying lithium-poisoned patients who may benefit from haemodialysis remains highly challenging,” British Journal of Clinical Pharmacology. 2020.
N. Harbord, “Common Toxidromes and the Role of Extracorporeal Detoxification,” Advances in Chronic Kidney Disease. 2020.
D. Vodovar, S. Beaune, J. Langrand, E. Vicaut, L. Labat, and B. Mégarbane, “Assessment of Extracorporeal Treatments in Poisoning criteria for the decision of extracorporeal toxin removal in lithium poisoning,” Br. J. Clin. Pharmacol., 2020.
N. A. Buckley et al., “Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines,” Br. J. Clin. Pharmacol., 2020.
B. S. Decker et al., “Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP workgroup,” Clin. J. Am. Soc. Nephrol., 2015.
A. R. Bailey, V. J. Sathianathan, A. L. Chiew, A. D. Paterson, B. S. H. Chan, and S. Arora, “Comparison of intermittent haemodialysis, prolonged intermittent renal replacement therapy and continuous renal replacement haemofiltration for lithium toxicity: A case report,” Crit. Care Resusc., 2011.
G. Ouellet, J. Bouchard, M. Ghannoum, and B. S. Decker, “Available extracorporeal treatments for poisoning: Overview and limitations,” Semin. Dial., 2014.
V. Lavergne et al., “Guidelines for reporting case studies on extracorporeal treatments in poisonings: Methodology,” Semin. Dial., 2014.
Brian S. Decker, et al. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol, 2015. DOI: 10.2215/CJN.10021014.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186