Lithium Toxicity: An Iatrogenic Problem in Susceptible Individuals

Abstract

Severe lithium neurotoxicity occurs almost exclusively in the context of chronic therapeutic administration of lithium, and rarely results from acute ingestion of lithium, even in patients currently taking lithium. As such it is an iatrogenic illness, occurring in patients who have identifiable clinical risk factors: nephrogenic diabetes insipidus, older age, abnormal thyroid function and impaired renal function. Although administration of drugs which impair lithium clearance appeared to contribute minimally to chronic lithium poisoning in the absence of other factors, these drugs may well 'uncover' the predisposing risk factors and certainly should not be considered safe to use as a consequence of this study. The serious morbidity suffered by lithium toxic patients, and the cost to society due to long hospital stays, might be reduced by careful prescribing, vigilant monitoring and awareness of these factors, as they develop in otherwise stable patients. Review of existing therapeutic guidelines may be warranted.

Renal effects of long‐term lithium therapy in the elderly: a cross‐sectional study

“…This was studied with the above mentioned questionnaire. As a reduced Umax with polyuria can increase the risk for dehydration and thereby for lithium intoxication this was also registered for every patient (Oakley et al, 2001).…”

Acute Encephalopathies and Psychiatry

“…Nephrogenic diabetes insipidus occurs in 10% of treated patients and causes dehydration, possibly precipitating toxicity and an encephalopathy. For people over 65 years-of-age, with impaired renal function and polypharmacy, the risk for this adversity increases by two-fold 14,15 . When co-prescribed with diuretics (e.g., hydrochlorthiazide), non-steriodal anti-inflammatory drugs (e.g., ibuprofen), and/or angiotensin converting enzyme inhibitors (e.g., captopril), lithium excretion is reduced leading to potential toxicity if dose adjustment is not made 15 .…”

“…At higher blood levels, severe toxicity includes delirium, seizures, coma, and even death; in these cases, blood concentrations are less well correlated to clinical status. Neurotoxicity with permanent sequellae follows high level intoxication 15 . Thus, significant toxicity mandates hydration and immediate discontinuation of lithium; hemodialysis maybe required.…”

Nitrergic, glutamatergic and gabaergic systems in lithium toxicity

“…Accordingly, it has been found that the CNS is mainly affected area (Sheean, 1991;Suraya and Yoong, 2001;Oakley et al, 2001).…”