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The mystery of lithium poisoning: Do you know those early symptoms that make people shudder?
Lithium toxicity, also known as lithium overdose, is a health condition caused by excessive levels of lithium in the body. Lithium is commonly used to treat bipolar disorder and its pharmacological effects are effective, but if the dose is too high or the elimination mechanism is impaired, it may cause serious health problems. The early symptoms of lithium toxicity, in particular, can often be disconcerting because they can sometimes be easily confused with other common conditions, making it difficult for patients to get timely treatment.
Symptoms of lithium toxicity range from mild nausea and drowsiness to severe coma, seizures, and possibly death.
Symptoms of lithium poisoning
Depending on the concentration of lithium in the blood, the symptoms of lithium poisoning can be divided into mild, moderate or severe. At lithium levels between 1.5 and 2.5 mEq/L, patients may experience mild symptoms such as nausea, tiredness, and tremors. As levels increase to 2.5 to 3.5 mEq/L, moderate symptoms may develop, including confusion, increased heart rate, and decreased muscle tone.
The most severe symptoms occur at concentrations above 3.5 mEq/L and include coma, seizures, low blood pressure, and elevated temperature. When lithium overdose causes neuropathy or cardiotoxicity, these symptoms are considered dangerous and potentially life-threatening.
Acute and chronic poisoning
Patients with acute lithium toxicity typically experience primarily gastrointestinal symptoms, most commonly vomiting and diarrhea, which may lead to fluid loss. During this phase, lithium further penetrates into the central nervous system, causing mild neurological symptoms such as dizziness.
Patients with chronic poisoning more often experience neurological symptoms such as nystagmus, tremors, hyperreflexia, incoordination, and altered mental status than those with acute poisoning. The gastrointestinal symptoms of chronic poisoning are relatively subtle, and are often subtle and non-specific.
Potential complicationsPeople who experience a poisoning incident may have persistent health problems. These persistent health symptoms are called syndrome of irreversible lithium effects (SILENT), which presents irreversible neurological and neuropsychiatric effects.
PathophysiologyThe neurological signs of SILENT syndrome include cerebellar dysfunction, extrapyramidal symptoms, and brainstem dysfunction, while the neuropsychiatric symptoms include memory deficits, cognitive deficits, and subcutaneous dementia.
Lithium is easily absorbed in the digestive tract and distributed throughout the body. The lithium concentration in the kidneys, thyroid gland, and bones is higher than in other tissues. Because lithium is almost entirely excreted by the kidneys, patients with chronic kidney disease are at higher risk of lithium toxicity. In addition, lithium itself is nephrotoxic, which increases the likelihood that toxicity will develop gradually at doses that were previously tolerated.
Diagnostic Methods
Diagnosis is usually based on symptoms, plus confirmation by blood tests for lithium. Blood tests will be done six to twelve hours after the last dose to ensure the accuracy of the results. Typically, lithium serum concentrations for treated patients are between 0.6 and 1.2 mEq/L.
Treatment options
If lithium toxicity is mild or moderate, the lithium dose may need to be reduced or stopped completely. For severe poisoning, lithium removal may be done in a hospital emergency department using methods such as gastric lavage and dialysis. Gastric washes involve placing a tube into the stomach to remove undigested lithium. For the most severe cases, dialysis is widely recommended to reduce the risk of permanent neurological sequelae.
Although dialysis can significantly accelerate the elimination of lithium, it remains unclear whether it can improve the long-term prognosis of patients.
The impact of lithium toxicity cannot be underestimated, both in terms of the diversity of its clinical symptoms and the possible long-term health conditions that may occur. Therefore, it is crucial for patients and their families to understand the early symptoms of lithium poisoning and its potential risks. Have you ever wondered how people who take lithium long-term can monitor themselves to avoid potential risks?
