Toxicology

Question 1

What are the main clinical features of large acute lithium OD

Answer 1

mainly GI
under 25g mild, over 25 mod to severe
neurotox rare

Question 2

What are the main clinical features of chronic

Answer 2

Neurotoxic:
Grade 1 = tremor, agitation, hyper-reflexia, ataxia
* Grade 2 = stupor, rigidity, hypotension
* Grade 3 = coma, seizures, myoclonus

Question 3

name three factors that predispose to chronic lithium toxicity

Answer 3

impaired kidney function
diabetis insipidus
dehydration
sodium depletion
drug interactions eg NSAIDS

Question 4

What is the modality for lithium enhanced elimination?
What are the indications?

Answer 4

haemodyalsis

Indications;
renal impairement
serum lithium >2.5
established neurotoxicity

Question 5

What agents may increase chance of heat stroke?

What are the methods for rapidly cooling?

Answer 5

MDMA
diuretics
salicylates
anticholinergic agents

Cooling:
Evaporative cooling eg spray and fan
ice packs to groin an axilla
arctic sun