Lithium Toxicity

Your Path

  • Lithium Toxicity


  • Risking level in setting of acute kidney injury
  • Intentional overdose
  • Overdose can be result of acute, chronic, or acute-on-chronic toxicity

Risk Factors

  • Bipolar disorder (reason for using Lithium)
  • Acute kidney injury, often coupled with NSAID use, ACE-I, hypovolemia/hypotension, drug-drug interactions
  • Refractory bipolar disease, such that Lithium is the only effective rx


  • Ataxia
  • Dizziness
  • Primary symptoms are neurologic; GI; renal (DI, ckd) in particular with chronic toxicity
  • Significant range in severity of symptoms, timing of onset and progression
  • Tremors (can be hands and legs) of new onset, without other explanation
  • Confusion lethargy
  • Nausea, vomiting, diarrhea
  • Polyuria, polydypsia (nephrogenic diabetes insipidus)

Physical Exam Findings

  • Tremor
  • Ataxia
  • Nystagmus
  • Hyper-reflexia
  • An array of findings with variable presentation
  • Myoclonic jerks, fasciculations
  • Hypotension, bradycardia