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Neurotoxicity in chronic lithium poisoning
Phyu M Hlaing1,2, Katherine Z Isoardi2,3, Colin B Page2,3
1Department of Internal Medicine, Redland Hospital, Brisbane, Queensland, Australia.
Internal Medicine Journal
|June 19, 2019
Summary
Lithium neurotoxicity can persist long after lithium levels normalize, especially in older adults with kidney issues. This prolonged delirium often leads to unnecessary tests and extended hospital stays.
Area of Science:
- Neuroscience
- Toxicology
- Nephrology
Background:
- Lithium neurotoxicity is often associated with chronic accumulation, with less focus on its protracted nature after lithium levels normalize.
- The literature underemphasizes the prolonged neurological effects of lithium toxicity even when serum concentrations return to therapeutic ranges.
Purpose of the Study:
- To characterize lithium-induced neurotoxicity to enhance clinical awareness of this phenomenon.
- To investigate the clinical features, course, and outcomes of lithium neurotoxicity.
Main Methods:
- Retrospective observational study of 22 patients presenting with lithium-induced neurotoxicity over 5 years.
- Analysis of clinical notes and unit databases for patient demographics, lithium concentrations, clinical presentation, and investigations.
Main Results:
- The median age of patients was 65 years; 41% were on medications impairing lithium excretion.
- Median lithium concentration was 2.2 mmol/L, normalizing in 3 days. 95% experienced reversible acute kidney injury.
- Predominant symptoms included confusion (95%), tremors (82%), and ataxia (73%). Median length of stay was 13 days due to delayed neurological recovery.
Conclusions:
- Lithium neurotoxicity exhibits a prolonged course, with severity poorly correlating to normalized lithium concentrations.
- Elderly patients with acute kidney injury are particularly susceptible, often experiencing prolonged delirium requiring extensive, yet unremarkable, investigations.
- Rationalizing lithium therapy, especially in the elderly, is crucial to prevent prolonged neurotoxicity and associated healthcare utilization.
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