- Risking level in setting of acute kidney injury
- Intentional overdose
- Overdose can be result of acute, chronic, or acute-on-chronic toxicity
- 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
- 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)
- An array of findings with variable presentation
- Myoclonic jerks, fasciculations
- Hypotension, bradycardia
- Lithium level
- Chemistry (creatinine, sodium in particular)
- Rule out co-ingestions, other toxic exposures