Acute Lithium ToxicityBoard Review Questions of the Week
Although accurate epidemiological data is not available, it is generally agreed that acute lithium toxicity is becoming a more frequent problem. Consequently recognition and treatment of lithium toxicity has also become more important. Acute lithium toxicity is generally subdivided into three grades: mild, moderate, and severe. Test your knowledge of Toxicologic disorders with this quick quiz question, courtesy of Med-Challenger online medical education.
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Lithium Toxicity Case:
A 32-year-old woman is seen 6 hours after an acute overdose with a friend's sustained-release (SR) lithium. The bottle contained 60 pills of SR 450 mg lithium, which was filled 2 days earlier and is now empty. She reports taking several handfuls. She denies any coingestion. She has had nausea and abdominal cramping but no vomiting.
Her past history is significant only for post-traumatic stress disorder and her only medication is as-needed hydroxyzine.
On examination, she is alert and anxious.
- BP 110/60 mm Hg
- Pulse 100 beats/minute
- RR 16 breaths/minute
- Temperature 37.0°C.
Her pupils are normal. Heart, lung and abdomen examinations are all normal. Neurologic examination reveals a coordinated gait, normal motor tone, no tremor, and brisk reflexes. Her skin is warm and dry.
Laboratory studies reveal:
- Sodium 140 mEq/L
- Potassium 4.3 mEq/L
- Chloride 104 mEq/L
- Bicarbonate 24 mEq/L
- Blood urea nitrogen 12 mg/dL
- 0.7 mg/dL
- Lithium level 4.6 mEq/L
- Acetaminophen level < 10 mcg/mL
- Negative pregnancy test
Appropriate management of this patient at this time is?
Begin intravenous fluids, consider whole bowel irrigation, and emergently consult nephrology for immediate hemodialysis
Begin intravenous fluids and hemodialysis
Begin gastric lavage followed by sodium polystyrene sulfonate and intravenous fluids at twice maintenance
Begin multidose activated charcoal and hemodialysis
See the answer...
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