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Facing a lithium poisoning emergency: What miraculous treatments are available in hospitals?
Lithium poisoning, or lithium excess, is a condition caused by excessive lithium content in the body. This condition can be triggered by excessive uptake or decreased renal excretion capacity. Symptoms may include tremors, enhanced reflexes, difficulty walking, kidney problems and altered consciousness. Notably, some symptoms may persist for up to a year after blood lithium levels return to normal. Immediate management of such an emergency is crucial because complications of this condition, such as serotonin syndrome, can also trigger other health problems.
Diagnosis of lithium poisoning is usually based on patient symptoms as well as test results that serum lithium levels are greater than 1.2 mEq/L.
Signs and Symptoms of Lithium Poisoning
Symptoms of lithium poisoning can be divided into mild, moderate and severe. Mild symptoms such as nausea, fatigue, and trembling usually occur at blood lithium levels of 1.5 to 2.5 mEq/L, moderate symptoms include confusion, rapid heartbeat, and low muscle tension, usually occurring at 2.5 to 3.5 mEq/L; Severe symptoms such as coma, epileptic seizures, hypotension and hyperthermia may occur at lithium concentrations above 3.5 mEq/L.
Acute and chronic poisoning
In cases of acute poisoning, patients usually present with symptoms dominated by digestive tract symptoms, such as vomiting and diarrhea, which can lead to fluid deficiency. Meanwhile, lithium is gradually distributed within the central nervous system, producing dizziness and other mild neurological symptoms.
Chronic poisoning manifests mainly neurological symptoms such as nystagmus, tremor, hyperreflexia and ataxia, while changes in mental state may also occur. In this process, the manifestations of digestive symptoms are less pronounced than acute poisoning.
Complications and sequelae
Surviving patients may develop enduring health problems known as irreversible lithium effect neurotoxic syndrome (SILENT), which are characterized by irreversible neurological and neuropsychiatric effects. The syndrome manifests as neurological signs such as cerebellar insufficiency, extrapyramidal system symptoms and brainstem dysfunction, and neuropsychiatric manifestations such as memory deficits, cognitive deficits and subcortical dementia.
Lithium is absorbed primarily in the digestive tract and is distributed to a higher standard in the kidneys, thyroid and bones.
Diagnostic Process
The diagnosis of lithium poisoning relies primarily on the patient’s symptoms and blood tests. The most effective time for a blood test is six to twelve hours after the last lithium medication taken, and serum lithium levels under normal treatment are between about 0.6-1.2 mEq/L. Your doctor also performs a series of tests to rule out the possibility of other acute poisonings, including blood sugar tests and kidney function assessments.
Treatment of lithium poisoning
In cases of mild or moderate lithium poisoning, doctors usually reduce or stop the dose of lithium entirely; In the hospital emergency department, such exclusions may include:
- Gastric wash: A tube is inserted into the stomach through the nose or mouth to remove undigested lithium.
- Dialysis: This is considered in the most severe cases for cleansing the blood.
- Diuretics: such as furosemide, and intravenous rehydration is performed to promote the elimination of lithium.
Hemodialysis is widely recommended as a means to reduce the risk of developing permanent neurological sequelae after lithium poisoning.
Although dialysis can effectively accelerate the exclusion of lithium, it is not fully understood whether it can improve patient prognosis. According to reports, about 5,000 lithium poisoning cases are reported to poison control centers in the United States each year. It was not until 1898 that lithium poisoning was first described.
In emergency medicine, in the face of emergency cases of lithium poisoning, is the response speed of medical providers and whether the treatments adopted can effectively reduce the patient's subsequent health risks? Is it a question worth pondering?
