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6 - Lithium Toxicity

Manifestations and Management of Lithium Toxicity and Overdose; Debate About Hemodialysis Implementation; Safe Use of Lithium During ECT; Clinical Situations When Lithium Should Be Temporarily Discontinued

Published online by Cambridge University Press:  09 February 2024

Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Medical journals from the late nineteenth and early twentieth centuries contained descriptions of lithium toxicity derived from animal experiments, some of which resulted in fatal outcomes; however, a 1903 paper reviewed this animal and human literature extensively and noted that, when lithium carbonate was used in daily doses of 975 mg – 1300 mg as a putative gout treatment, the adverse effects were quite modest and gastrointestinal in nature [2]. Perhaps emboldened by this finding, a Michigan physician, Dr. Clarence Cleaveland, decided in 1913 to experiment on himself by ingesting 14 grams (g) of lithium chloride (equivalent to 12,380 mg of lithium carbonate) in divided doses over a period of 28 h (2 g at 1 pm, 9 pm and 7 am, then 8 g at 7 pm) and document the outcome [3].

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Chapter
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The Lithium Handbook
Stahl's Handbooks
, pp. 329 - 361
Publisher: Cambridge University Press
Print publication year: 2023

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References

Cade, J. F. J. (1949). Lithium salts in the treatment of psychotic excitement. Med J Aust, 36, 349351.CrossRefGoogle Scholar
Good, C. A. (1903). An experimental study of lithium. Am J Med Sci, 125, 273284.CrossRefGoogle Scholar
Cleaveland, S. A. (1913). A case of poisoning by lithium presenting some new features. JAMA, 60, 722.CrossRefGoogle Scholar
Corcoran, A. C., Taylor, R. D. and Page, I. H. (1949). Lithium poisoning from the use of salt substitutes. JAMA, 139, 685688.CrossRefGoogle ScholarPubMed
Hanlon, L. W., Romaine III, M., Gilroy, F. J., et al. (1949). Lithium chloride as a substitute for sodium chloride in the diet: Observations on its toxicity. JAMA, 139, 688692.CrossRefGoogle ScholarPubMed
Peters, H. A. (1949). Lithium intoxication producing chorea athetosis with recovery. Wis Med J, 48, 1075.Google ScholarPubMed
Stern, R. L. (1949). Severe lithium chloride poisoning with complete recovery; report of case. JAMA, 139, 710.CrossRefGoogle ScholarPubMed
Waldron, A. M. (1949). Lithium intoxication occurring with the use of a table salt substitute in the low sodium dietary treatment of hypertension and congestive heart failure. Univ Hosp Bull, 15, 9.Google ScholarPubMed
Cade, J. F. (1999). John Frederick Joseph Cade: Family memories on the occasion of the 50th anniversary of his discovery of the use of lithium in mania. 1949. Aust N Z J Psychiatry, 33, 615618.CrossRefGoogle Scholar
Roberts, E. L. (1950). A case of chronic mania treated with lithium citrate and terminating fatally. Med J Aust, 2, 261262.CrossRefGoogle ScholarPubMed
Noack, C. H. and Trautner, E. M. (1951). The lithium treatment of maniacal psychosis. Med J Aust, 2, 219222.CrossRefGoogle ScholarPubMed
Talbott, J. H. (1950). Use of lithium salts as a substitute for sodium chloride. Arch Int Med, 85, 110.CrossRefGoogle ScholarPubMed
Wynn, V., Simon, S., Morris, R. J., et al. (1950). The clinical significance of sodium and potassium analyses of biological fluids: Their estimation by flame spectrophotometry. Med J Aust, 1, 821835.CrossRefGoogle ScholarPubMed
Johnson, G. and Gershon, S. (1999). Early North American research on lithium. Aust N Z J Psychiatry, 33 Suppl., S4853.CrossRefGoogle ScholarPubMed
Offerman, S. R., Alsop, J. A., Lee, J., et al. (2010). Hospitalized lithium overdose cases reported to the California Poison Control System. Clin Toxicol (Phila), 48, 443448.CrossRefGoogle Scholar
Nelson, J. C. and Spyker, D. A. (2017). Morbidity and mortality associated with medications used in the treatment of depression: An analysis of cases reported to U.S. poison control centers, 2000–2014. Am J Psychiatry, 174, 438450.CrossRefGoogle ScholarPubMed
Schou, M. (1984). Long-lasting neurological sequelae after lithium intoxication. Acta Psychiatr Scand, 70, 594602.CrossRefGoogle ScholarPubMed
Verdoux, H., Debruyne, A. L., Queuille, E., et al. (2021). A reappraisal of the role of fever in the occurrence of neurological sequelae following lithium intoxication: A systematic review. Expert Opin Drug Saf, 20, 827838.CrossRefGoogle ScholarPubMed
El-Mallakh, R. S. (1986). Acute lithium neurotoxicity. Psychiatric Developments, 4, 311328.Google ScholarPubMed
El-Mallakh, R. S. (1984). Treatment of acute lithium toxicity. Vet Hum Toxicol, 26, 3135.Google ScholarPubMed
Aiff, H., Attman, P.-O., Aurell, M., et al. (2014). The impact of modern treatment principles may have eliminated lithium-induced renal failure. J Psychopharmacol, 28, 151154.CrossRefGoogle ScholarPubMed
Ott, M., Stegmayr, B., Salander Renberg, E., et al. (2016). Lithium intoxication: Incidence, clinical course and renal function – a population-based retrospective cohort study. J Psychopharmacol, 30, 10081019.CrossRefGoogle ScholarPubMed
Nolen, W. A., Licht, R. W., Young, A. H., et al. (2019). What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar Disord, 21, 394409.CrossRefGoogle ScholarPubMed
Heath, L. J., Billups, S. J., Gaughan, K. M., et al. (2018). Risk factors for utilization of acute care services for lithium toxicity. Psychiatr Serv, 69, 671676.CrossRefGoogle ScholarPubMed
Oakley, P. W., Whyte, I. M. and Carter, G. L. (2001). Lithium toxicity: An iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry, 35, 833840.CrossRefGoogle ScholarPubMed
Bisogni, V., Rossitto, G., Reghin, F., et al. (2016). Antihypertensive therapy in patients on chronic lithium treatment for bipolar disorders. J Hypertens, 34, 2028.CrossRefGoogle ScholarPubMed
Juurlink, D. N., Mamdani, M. M., Kopp, A., et al. (2004). Drug-induced lithium toxicity in the elderly: A population-based study. J Am Geriatr Soc, 52, 794798.CrossRefGoogle ScholarPubMed
Ayub, S., Saboor, S., Usmani, S., et al. (2022). Lithium toxicity following Roux-en-Y gastric bypass: Mini review and illustrative case. Ment Health Clin, 12, 214218.CrossRefGoogle ScholarPubMed
Richards, E., Pankhania, M., Thomas, C., et al. (2022). Perioperative management of lithium in the patient undergoing pituitary surgery: A case report. Br J Neurosurg. https://doi.org/10.1080/02688697.2021.2010651.CrossRefGoogle Scholar
Pi, H. T. and Surawicz, F. G. (1978). Severe neurotoxicity and lithium therapy. Clin Toxicol, 13, 479486.Google ScholarPubMed
Pai, N. M., Malyam, V., Murugesan, M., et al. (2022). Lithium toxicity at therapeutic doses as a fallout of COVID-19 infection: A case series and possible mechanisms. Int Clin Psychopharmacol, 37, 2528.CrossRefGoogle ScholarPubMed
Tobita, S., Sogawa, R., Murakawa, T., et al. (2021). The importance of monitoring renal function and concomitant medication to avoid toxicity in patients taking lithium. Int Clin Psychopharmacol, 36, 3437.CrossRefGoogle ScholarPubMed
Decker, B. S., Goldfarb, D. S., Dargan, P. I., et al. (2015). Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol, 10, 875887.CrossRefGoogle ScholarPubMed
Buckley, N. A., Cheng, S., Isoardi, K., et al. (2020). Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines. Br J Clin Pharmacol, 86, 9991006.CrossRefGoogle ScholarPubMed
Vodovar, D., Beaune, S., Langrand, J., et al. (2020). Assessment of Extracorporeal Treatments in Poisoning criteria for the decision of extracorporeal toxin removal in lithium poisoning. Br J Clin Pharmacol, 86, 560568.CrossRefGoogle ScholarPubMed
Dolenc, T. J. and Rasmussen, K. G. (2005). The safety of electroconvulsive therapy and lithium in combination: A case series and review of the literature. J ECT, 21, 165170.CrossRefGoogle ScholarPubMed
Elias, A., Thomas, N. and Sackeim, H. A. (2021). Electroconvulsive therapy in mania: A review of 80 years of clinical experience. Am J Psychiatry, 178, 229239.CrossRefGoogle Scholar
Lisanby, S. H., McClintock, S. M., McCall, W. V., et al. (2022). Longitudinal neurocognitive effects of combined electroconvulsive therapy (ECT) and pharmacotherapy in major depressive disorder in older adults: Phase 2 of the PRIDE study. Am J Geriatr Psychiatry, 30, 1528.CrossRefGoogle ScholarPubMed
Hansen, H. E. and Amdisen, A. (1978). Lithium intoxication. (Report of 23 cases and review of 100 cases from the literature.). Q J Med, 47, 123144.Google ScholarPubMed
Jaeger, A., Sauder, P., Kopferschmitt, J., et al. (1993). When should dialysis be performed in lithium poisoning? A kinetic study in 14 cases of lithium poisoning. J Toxicol Clin Toxicol, 31, 429447.CrossRefGoogle ScholarPubMed
Hiemke, C., Bergemann, N., Clement, H. W., et al. (2018). Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017. Pharmacopsychiatry, 51, 962.Google ScholarPubMed
Ferrey, A. E., Geulayov, G., Casey, D., et al. (2018). Relative toxicity of mood stabilisers and antipsychotics: Case fatality and fatal toxicity associated with self-poisoning. BMC Psychiatry, 18, 399.CrossRefGoogle ScholarPubMed
Tsai, C. J., Cheng, C., Chou, P. H., et al. (2016). The rapid suicide protection of mood stabilizers on patients with bipolar disorder: A nationwide observational cohort study in Taiwan. J Affect Disord, 196, 7177.CrossRefGoogle ScholarPubMed
Baldessarini, R. J., Tondo, L., Davis, P., et al. (2006). Decreased risk of suicides and attempts during long-term lithium treatment: A meta-analytic review. Bipolar Disord, 8, 625639.CrossRefGoogle ScholarPubMed
Komoroski, R. A., Newton, J. E., Sprigg, J. R., et al. (1993). In vivo 7Li nuclear magnetic resonance study of lithium pharmacokinetics and chemical shift imaging in psychiatric patients. Psychiatry Res, 50, 6776.CrossRefGoogle ScholarPubMed
Plenge, P., Stensgaard, A., Jensen, H. V., et al. (1994). 24-hour lithium concentration in human brain studied by Li-7 magnetic resonance spectroscopy. Biol Psychiatry, 36, 511516.CrossRefGoogle ScholarPubMed
Baird-Gunning, J., Lea-Henry, T., Hoegberg, L. C. G., et al. (2017). Lithium poisoning. J Intensive Care Med, 32, 249263.CrossRefGoogle ScholarPubMed
Amdisen, A. and Skjoldborg, H. (1969). Haemodialysis for lithium poisoning. Lancet, 2, 213.CrossRefGoogle ScholarPubMed
Schou, M., Amdisen, A. and Trap-Jensen, J. (1968). Lithium poisoning. Am J Psychiatry, 125, 520527.CrossRefGoogle ScholarPubMed
Dyson, E. H., Simpson, D., Prescott, L. F., et al. (1987). Self-poisoning and therapeutic intoxication with lithium. Hum Toxicol, 6, 325329.CrossRefGoogle ScholarPubMed
Eyer, F., Pfab, R., Felgenhauer, N., et al. (2006). Lithium poisoning: Pharmacokinetics and clearance during different therapeutic measures. J Clin Psychopharmacol, 26, 325330.CrossRefGoogle ScholarPubMed
Kores, B. and Lader, M. H. (1997). Irreversible lithium neurotoxicity: An overview. Clin Neuropharmacol, 20, 283299.CrossRefGoogle ScholarPubMed
Soares, J. C., Boada, F. and Keshavan, M. S. (2000). Brain lithium measurements with (7)Li magnetic resonance spectroscopy (MRS): A literature review. Eur Neuropsychopharmacol, 10, 151158.CrossRefGoogle Scholar
Forester, B. P., Streeter, C. C., Berlow, Y. A., et al. (2009). Brain lithium levels and effects on cognition and mood in geriatric bipolar disorder: A lithium-7 magnetic resonance spectroscopy study. Am J Geriatr Psychiatry, 17, 1323.CrossRefGoogle ScholarPubMed
Lee, J. H., Adler, C., Norris, M., et al. (2012). 4-T 7Li 3D MR spectroscopy imaging in the brains of bipolar disorder subjects. Magn Reson Med, 68, 363368.CrossRefGoogle ScholarPubMed
Moore, C. M., Demopulos, C. M., Henry, M. E., et al. (2002). Brain-to-serum lithium ratio and age: An in vivo magnetic resonance spectroscopy study. Am J Psychiatry, 159, 12401242.CrossRefGoogle ScholarPubMed
Machado-Vieira, R., Otaduy, M. C., Zanetti, M. V., et al. (2016). A selective association between central and peripheral lithium levels in remitters in bipolar depression: A 3 T-(7) Li magnetic resonance spectroscopy study. Acta Psychiatr Scand, 133, 214220.CrossRefGoogle Scholar
Abdel-Zaher, A. O. (2000). The myoneural effects of lithium chloride on the nerve–muscle preparations of rats: Role of adenosine triphosphate-sensitive potassium channels. Pharmacol Res, 41, 163178.CrossRefGoogle ScholarPubMed
Jefferson, J. W. (1978). Lithium–pancuronium interaction. Ann Intern Med, 88, 577.CrossRefGoogle ScholarPubMed
Kishimoto, N., Yoshikawa, H. and Seo, K. (2020). Potentiation of rocuronium bromide by lithium carbonate: A case report. Anesth Prog, 67, 146150.CrossRefGoogle ScholarPubMed
Aref, M. A., El-Badramany, M., Hannora, N., et al. (1982). Lithium loss in sweat. Psychosomatics, 23, 407.CrossRefGoogle ScholarPubMed
Jefferson, J. W., Greist, J. H., Clagnaz, P. J., et al. (1982). Effect of strenuous exercise on serum lithium level in man. Am J Psychiatry, 139, 15931595.Google ScholarPubMed
Grandjean, E. M. and Aubry, J.-M. (2009). Lithium: Updated human knowledge using an evidence-based approach. Part III: Clinical safety. CNS Drugs, 23, 397418.CrossRefGoogle ScholarPubMed
Wilting, I., Fase, S., Martens, E. P., et al. (2007). The impact of environmental temperature on lithium serum levels. Bipolar Disord, 9, 603608.CrossRefGoogle ScholarPubMed
Cheng, S., Buckley, N. A., Siu, W., et al. (2020). Seasonal and temperature effect on serum lithium concentrations. Aust N Z J Psychiatry, 54, 282287.CrossRefGoogle ScholarPubMed
Merwick, A., Cooke, J., Neligan, A., et al. (2011). Acute neuropathy in setting of diarrhoeal illness and hyponatraemia due to lithium toxicity. Clin Neurol Neurosurg, 113, 923924.CrossRefGoogle ScholarPubMed
Davis, J., Desmond, M. and Berk, M. (2018). Lithium and nephrotoxicity: A literature review of approaches to clinical management and risk stratification. BMC Nephrol, 19, 305.CrossRefGoogle ScholarPubMed
Davis, J., Desmond, M. and Berk, M. (2018). Lithium and nephrotoxicity: Unravelling the complex pathophysiological threads of the lightest metal. Nephrology (Carlton), 23, 897903.CrossRefGoogle ScholarPubMed
Arancibia, A., Paulos, C., Chavez, J., et al. (2003). Pharmacokinetics of lithium in healthy volunteers after exposure to high altitude. Int J Clin Pharmacol Ther, 41, 200206.CrossRefGoogle ScholarPubMed
Uber, A. and Twark, C. (2022). Symptom overlap of acute mountain sickness and lithium toxicity: A case report. High Alt Med Biol, 23, 291293.Google ScholarPubMed
Thomsen, K. and Schou, M. (1968). Renal lithium excretion in man. Am J Physiol, 215, 823827.CrossRefGoogle ScholarPubMed
McGrane, I. R., Salyers, L. A., Molinaro, J. R., et al. (2021). Roux-en-Y gastric bypass and antipsychotic therapeutic drug monitoring: Two cases. 34, 3, 503506.CrossRefGoogle Scholar
Bingham, K. S., Thoma, J., Hawa, R., et al. (2016). Perioperative lithium use in bariatric surgery: A case series and literature review. Psychosomatics, 57, 638644.CrossRefGoogle ScholarPubMed
Musfeldt, D., Levinson, A., Nykiel, J., et al. (2016). Lithium toxicity after Roux-en-Y bariatric surgery. BMJ Case Rep, 2016.CrossRefGoogle Scholar
Niessen, R., Sottiaux, T., Schillaci, A., et al. (2018). [Lithium toxicity after bariatric surgery]. Rev Med Liege, 73, 8287.Google ScholarPubMed
Dahan, A., Porat, D., Azran, C., et al. (2019). Lithium toxicity with severe bradycardia post sleeve gastrectomy: A case report and review of the literature. Obes Surg, 29, 735738.CrossRefGoogle ScholarPubMed
Jamison, S. C. and Aheron, K. (2020). Lithium toxicity following bariatric surgery. SAGE Open Med Case Rep, 8, 2050313x20953000.Google ScholarPubMed
Lin, Y. H., Liu, S. W., Wu, H. L., et al. (2020). Lithium toxicity with prolonged neurologic sequelae following sleeve gastrectomy: A case report and review of literature. Medicine (Baltimore), 99, e21122.CrossRefGoogle ScholarPubMed
Marques, A. R., Alho, A., Martins, J. M., et al. (2021). Lithium intoxication after bariatric surgery: A case report. Acta Med Port, 34, 382386.CrossRefGoogle ScholarPubMed

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  • Lithium Toxicity
  • Jonathan M. Meyer, University of California, San Diego, Stephen M. Stahl, University of California, San Diego
  • Book: The Lithium Handbook
  • Online publication: 09 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009225069.009
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  • Lithium Toxicity
  • Jonathan M. Meyer, University of California, San Diego, Stephen M. Stahl, University of California, San Diego
  • Book: The Lithium Handbook
  • Online publication: 09 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009225069.009
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Lithium Toxicity
  • Jonathan M. Meyer, University of California, San Diego, Stephen M. Stahl, University of California, San Diego
  • Book: The Lithium Handbook
  • Online publication: 09 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009225069.009
Available formats
×