Treatment of acute lithium toxicity

Although accurate epidemiological data is not available, it is generally agreed that acute lithium toxicity is becoming a more frequent problem. Consequently recognition and treatment of lithium toxicity has also become more important. Acute lithium toxicity is generally subdivided into three grades: mild, moderate, and severe. Mild toxicity can often be managed successfully with minimal intervention; often only cessation or reduction of lithium doses is sufficient. Moderate and severe toxicity both require more aggressive approaches. Initial general anti-poisoning measures, such as gastric lavage, may be helpful, but the ultimate success of treatment depends upon the elimination of lithium from the body. Hemodialysis, and, to a lesser extent, peritoneal dialysis, will both rapidly eliminate lithium from the body. Sodium administration, and the maintenance of high-normal sodium levels, may also reduce the severity of lithium toxicity by removing the dangerous intracellular fraction of lithium from inside excitable cells.