Page 1 of 1: Lithium

ieva · Credits: 3579 My Scrapbook

A 25-year-old man with a known history of bipolar disorder and substance abuse presents with mild lethargy after ingesting an unknown amount of lithium. His BP is 110/70 mm Hg; pulse, 108 beats/min; temperature, 97.8°F; and lithium level, 2.5 mEq/L (therapeutic range, 0.6-1.2 mEq/L). What would be the most appropriate next step?

1. Administer activated charcoal
2. Initiate whole-bowel irrigation
3. Determine the time and amount of ingestion
4. Arrange for urgent hemodialysis
5. Initiate forced saline diuresis

cafe · Credits: 5230 My Scrapbook

A 25-year-old man with a known history of bipolar disorder and substance abuse presents with mild lethargy after ingesting an unknown amount of lithium. His BP is 110/70 mm Hg; pulse, 108 beats/min; temperature, 97.8°F; and lithium level, 2.5 mEq/L (therapeutic range, 0.6-1.2 mEq/L). What would be the most appropriate next step?

1. Administer activated charcoal
2. Initiate whole-bowel irrigation
3. Determine the time and amount of ingestion /////
4. Arrange for urgent hemodialysis
5. Initiate forced saline diuresis

ameena · Credits: 237 My Scrapbook

Arrange for urgent hemodialysis

cafe · Credits: 5230 My Scrapbook

I am not sure that this is next step. Here some info....

"The severity of lithium toxicity is related to both the serum lithium level and the duration of the elevated level. Even in acute overdose, symptoms may not be fully apparent for up to 48 h. As a general rule, lithium toxicity is rare at serum levels of less than 2 mEq/L. Early signs of toxicity include nausea and vomiting, dysarthria, lethargy, and a coarse hand tremor. As toxicity worsens, neurologic symptoms increase. Ataxia, myasthenia, incoordination, hyperreflexia, muscle fasciculation, blurred vision, and scotomas may develop. Eventually, confusion, choreoathetosis, myoclonus, and seizures occur, and the patient may finally become comatose. Cardiovascular toxicity is unusual at serum levels of less than 4 mEq/L. In addition to nonspecific T-wave changes, high lithium levels may be associated with hypotension, atrioventricular conduction defects, ventricular tachydysrhythmias, and eventually complete cardiovascular collapse.
With blood levels of lithium in the upper therapeutic range, it is not uncommon to observe a fast-frequency action tremor or asterixis, together with nausea, loose stools, fatigue, polydipsia, and polyuria. These symptoms usually subside with time. Above a level of 1.5 to 2 meq/L, particularly in patients with impaired renal function or in those taking a thiazide diuretic, serious intoxication becomes manifest—clouding of consciousness, confusion, delirium, dizziness, nystagmus, ataxia, stammering, diffuse myoclonic twitching, and nephrogenic diabetes insipidus. Vertical (downbeating) nystagmus and opsoclonus may also be prominent. This clinical state, particularly confusion and myoclonus associated with sharp waves in the EEG, may mimic Creutzfeldt-Jakob disease (Subacute Spongiform Encephalopathy [Creutzfeldt-Jakob Disease]), but there should be no problem in diagnosis if the setting of the illness and the administration of lithium are known. At a blood lithium concentration of 3.5 meq/L, these symptoms are replaced by stupor and coma, sometimes with convulsions, and may prove fatal.
Discontinuing lithium in the intoxicated patient, which is the initial step in therapy, does not result in immediate disappearance of toxic symptoms. This may be delayed by a week or two, and the diabetes insipidus may persist even longer. Fluids, sodium chloride, aminophylline, and acetazolamide promote the excretion of lithium. Lithium coma may require hemodialysis, which has proved to be the most rapid means of reducing the blood lithium concentration.

TREATMENT OF LITHIUM INTOXICATION
There is no specific antidote for Li+ intoxication, and treatment is supportive. Vomiting induced by rapidly rising plasma Li+ may tend to limit absorption, but fatalities have occurred. Care must be taken to assure that the patient is not Na+- and water-depleted. Dialysis is the most effective means of removing the ion from the body and is necessary in severe poisonings, i.e., in patients exhibiting symptoms of toxicity or patients with serum Li+ concentrations greater than 4 mEq/L in acute overdoses or greater than 1.5 mEq/L in chronic overdoses."

mcc16 · Credits: 18325 My Scrapbook

agreed, hemodialysis is done at >3.5 lithium level.

ieva · Credits: 3579 My Scrapbook

Guys, what if this qn is meant to catch us if we know the order of management in the case of poisoning?
What if with words "after ingesting an unknown amount of lithium" they want to see us if we do right with asking patient for the time and amount of ingestion ?
By book "when?" and "how much?" must be first qns asked in case of poisoning. And patient is conscious!
Maybe the right answer is: 3. Determine the time and amount of ingestion ?

drsahar · Credits: 2137 My Scrapbook

that does makes sense...they want us to know how to manage patients initially as General Practitioners

mikejonathan20055 · Credits: 3355 My Scrapbook

A 25-year-old man with a known history of bipolar disorder and substance abuse presents with mild lethargy after ingesting an unknown amount of lithium. His BP is 110/70 mm Hg; pulse, 108 beats/min; temperature, 97.8°F; and lithium level, 2.5 mEq/L (therapeutic range, 0.6-1.2 mEq/L). What would be the most appropriate next step?

1. Administer activated charcoal
2. Initiate whole-bowel irrigation
3. Determine the time and amount of ingestion
4. Arrange for urgent hemodialysis-----------------
5. Initiate forced saline diuresis

Toronto Note : PS 49
Heamodialysis : if :
1. lithium more than 2 mmol/L
2. coma
3. shock
4.sever dehydration
5.failure to respond to the Rx within 24 h
6. Deterioration

Cheers

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