Epidemiology
Etiology
- Excessive intake
- Increase in prescribed dose (lithium has a narrow therapeutic window)
- Accidental or intentional overdose
- Decreased excretion
- Renal insufficiency
- Hypovolemia (e.g., due to vomiting, diarrhea, or water restriction)
- Medications that increase the renal absorption of lithium
Pathophysiology
Clinical features
- Gastrointestinal: nausea, vomiting, and diarrhea
- Neurological
- Altered mental status, confusion
- Somnolence, coma
- Delirium, encephalopathy, psychomotor impairment
- Coarse tremors, seizures, fasciculations, myoclonus
- Ataxia, slurred speech, nystagmus
- Hyperreflexia
Diagnostics
Treatment