In the case of extracorporeal treatments, there are observational data in its favor, without evidence from randomized controlled trials (none have been performed), which may lead to conservative practices and potentially unnecessary interventions in some circumstances. There is disagreement in the literature regarding factors that define patients most likely to benefit from treatments that enhance lithium elimination, including specific plasma lithium concentration thresholds. Lithium is readily dialyzable, and rationale support extracorporeal treatments to reduce the risk or the duration of toxicity in high-risk exposures. Persistent neurological deficits, in particular cerebellar, are described and the incidence and risk factors for its development are poorly understood, but it appears to be uncommon in uncomplicated acute poisoning. Lithium poisoning has a low mortality rate however, chronic lithium poisoning can require a prolonged hospital length of stay from impaired mobility and cognition and associated nosocomial complications. Lithium is a very powerful, antimanic medication with a narrow therapeutic index3.
Food and Drug Administration (FDA) as a mood-stabilizing medication for the treatment of mania in the 1970s2.
Lithium, a monovalent cation similar to sodium with an unknown mechanism, was first approved by the U.S. Lithium poisoning can affect multiple organs however, the primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. The drug of choice for recurrent bipolar illness management remains to be lithium1. This is most commonly due to impaired kidney function caused by volume depletion from lithium-induced nephrogenic diabetes insipidus or intercurrent illnesses and is also drug-induced. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Therefore, careful attention to dosing, monitoring, and titration is required. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Lithium is a commonly prescribed treatment for bipolar affective disorder.
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