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Bipolar disorder - Management
How do I know my patient has lithium toxicity?
- Lithium toxicity occurs at serum lithium concentrations of about 1.5 mmol/L and above, but may occur despite an apparently normal plasma level.
- Signs of toxicity include increasing diarrhoea, vomiting, anorexia, muscle weakness, lethargy, giddiness, ataxia, lack of coordination, tinnitus, blurred vision, coarse tremor of the extremities and lower jaw, muscle hyper-irritability, choreoathetoid movements, dysarthria, and drowsiness.
- Severe lithium toxicity occurs at serum lithium concentrations of about 2 mmol/L and above. Signs include, hyper-reflexia and hyperextension of limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, and occasionally death.
- The risk of toxicity is greater in people with hypertension, diabetes, congestive heart failure, chronic renal failure, schizophrenia, or Addison's disease.
[Sweetman, 2005; ABPI Medicines Compendium, 2006b]
Clarification / Additional information
The National Patient Safety Agency has developed a lithium patient information booklet. Copies can be obtained from nhsforms@spsl.uk.com.
Basis for recommendation
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