Management of lithium toxicity

IV: intravenous; eGFR: estimated glomerular filtration rate; SILENT: syndrome of irreversible lithium-effectuated neurotoxicity.

* Refer to UpToDate content on lithium poisoning for details on appropriate supportive care.

¶ Polyethylene glycol-electrolyte solution rate:

• Children 9 months to <6 years: 500 mL/hour
• Children ≥6 years to 12 years: 1000 mL/hour
• Adolescents and adults: 1500 to 2000 mL/hour

Δ Serum lithium concentrations do not always correlate with clinical signs of toxicity due to lithium's distribution into multiple other non-serum compartments.

◊ Impaired kidney function if any of the following:

• eGFR <45 mL/min
• Serum creatinine ≥2mg/dL in adults
• Serum creatinine ≥1.5 mg/dL in older adult or patient with low muscle mass
• Doubling of baseline serum creatinine, if known
• In child, serum creatinine greater than 2 times upper limit of normal for age and sex

§ Features of chronic lithium toxicity:

• Typically older individuals with baseline kidney function decline
• Did not take extra doses or overdose
• Inciting factor is hypovolemia or worsening kidney function
• Symptoms develop gradually
• Present with neurologic findings (eg, tremor, confusion)

¥ Continuous venovenous hemofiltration is an option if intermittent hemodialysis cannot be tolerated.