Lithium Flashcards
Signs of intoxication require treatment withdrawal. What are the signs of lithium overdose?
- Increasing GI disturbances (e.g. vomitting, diarrhoea)
- Visual disturbances
- Polyuria
- Muscle weakness
- Fine tremor, increasing to coarse tremor
- CNS disturbances (e.g. confusion, drowsiness, stupor, lack of coordination)
- Abnormal reflexes
- Myoclonus (involuntary twitching/jerking of muscles)
- Incontinence
- Hypernatraemia
What are signs of severe lithium overdose?
- Seizures
- Cardiac arrhythmias (including sinoatrial block, bradycardia, 1st degree heart block)
- BP changes (hypotension)
- Circulatory failure
- Renal failure
- Coma
- Sudden death
Most common reason for lithium intoxication
- Most often due to complication of long term lithium therapy, caused by reduced excretion of the drug
Factors that cause reduced excretion of lithium
- Dehydration
- Reduced renal function
- Infection
- Co-administration of drugs that interact e.g. diuretics and NSAIDs
Why might you get delayed onset of symptoms (12 hours or more) with acute deliberate overdose?
- Due to slow entry of lithium into tissues and continuing absorption from MR forms
What is the therapeutic serum-lithium concentration range?
0.4-1mmol/litre
Which concentration of serum-lithium is associated with serious toxicity? What might treatment consist of?
More than 2mmol/litre
May require haemodialysis if neurological symptoms or renal failure
Why should lithium be prescribed by brand
Preparations can vary widely in bioavailability
What are the two lithium salts available
Lithium carbonate & lithium citrate
They are NOT dose equivalent
How to manage acute overdose
- High serum-lithium concentrations may be present without features of toxicity
- Usually just need to take measures to increase urine output (e.g. increase fluid intake but AVOID diuretics)
- Otherwise, give supportive treatment and consider electrolyte balance, renal function, control of convulsions
- Consider gastric lavage if appropriate
- Consider whole-bowel irrigation for significant ingestion
When is gastric lavage appropriate in managing acute overdose
Consider it if it can be performed within 1 hour of ingesting significant quantities of lithium
Use of lithium salts in pregnancy
- Avoid if possible, esp in 1st trimester (teratogenic risk including cardiac abnormalities)
- Dose requirements increased during 2nd and 3rd trimester
- Return abruptly to normal dose on delivery of baby
- Close monitoring of serum-lithium concentration as risk of toxicity in neonate
Use of lithium salts when breastfeeding
Avoid - present in milk & risk of toxicity in infant
Use of lithium salts in renal impairment
Use with caution in mild-moderate impairment
Avoid in severe impairment
How many hours post-dose should serum lithium concentrations be taken?
12 hours
What is the serum lithium concentration that should be achieved, including the range for maintenance therapy & for elderly patients
0.4-1mmol/litre
Lower range of this for elderly & maintenance therapy