DR Medhat MRCP

- Features of acute lithium toxicity :
GIT :
1. Nausea & vomiting.
2. Abdominal pain & diarrhea.
CVS :
1. Cardiac dysrrhythmia ( sinus bradycardia, HB , junctional rhythm).
2. Hypotension.
Neurological :
1. Coarse tremors.
2. Acute confusion.
3. Seizure.
4. Coma
Renal : AKI ( from dehydration)
- Management of acute lithium toxicity:
1) Gastric lavage.
2) Stop lithium
3) Send for lithium blood level
< 2.5 mmol/L :
2.5-4 mmo/L :
Conservative management with I.V fluids (N.S)
without CNS manifistations : conservative TTT.
With CNS manifistations : dialysis (CVVHDF).
> 4 mmol/L ( with or without CNS manifistations ) : dialysis (CVVHDF).
4) Weak evidence of I.V NaHCO3 use to alkalynate the urine thus lithium excretion.
Perinatal psychiatric drug treatments :
Lithium : avoid lithium in pregnancy & after delivery because
1) 1 st trimester : it causes atrialization of right ventricle
2) Renal clearance of lithium falls abruptly after delivery leading to lithium toxicity
3) Lithium is secreted in breast milk so if infant is dehydrated, lithium toxicity occur.
Valproate & carbamazipine : avoid in pregnancy if possible.
Antidepressants :
o Amitriptyline & imipramine are used in pregnancy
o Tricyclics in 3 rd trimester may cause neonatal withdrawal effect e.g irritability &
seizures.
All psychotropic drugs are excreted in breast milk so avoid use of > one drug & check
the baby RFT & LFT and notice any irritability or sedation.
15