A serious health condition that causes neurological and intestinal symptoms and may lead to kidney failure is called lithium toxicity. It is considered a medical emergency that requires immediate treatment. Otherwise, it may lead to life-threatening complications (including death).
Most of the time, lithium toxicity occurs due to an overdose of prescription medications that contain lithium. Generally, lithium is a natural salt that reduces symptoms of mania. Usually, physicians recommend it for people with bipolar disorder, but it may also be used to relieve the symptoms of other health conditions. In any case, you should administer drugs that contain lithium exactly as recommended by your healthcare professional to avoid any adverse reactions.
Healthcare professionals have divided this condition into 3 categories based on how they occur. Examples include:
- Acute (sudden and severe) toxicity – It usually occurs when a person ingests a high dose of medicines that contain lithium at one time. Sometimes, it may happen if you have a reduced amount of water in the body.
- Acute-on-chronic toxicity – This form of lithium toxicity occurs when you administer an extra amount one day while following a treatment with lithium.
- Chronic (long-term) toxicity – Doctors usually recommend long-term use of medications that contain lithium for people with chronic health conditions. In such cases, they administer medications that contain lithium every day, which causes it to build up in the body. Some possible causes include dehydration, kidney health, and other medicines that interact with lithium.
Levels of Lithium Toxicity
Physicians usually determine the amount of lithium in the blood by performing a blood test. Check some general levels of lithium toxicity below:
- Mild toxicity – 1.5 to 2.5 mmol/L (millimeters per liter)
- Moderate toxicity – 2.5 to 3.5 mmol/L
- Severe toxicity – More than 3.5 mmol/L
What Are The Symptoms of Lithium Toxicity?
People usually experience different symptoms. Check below some symptoms according to the type of condition a person experiences:
Acute and Acute-On-Chronic Lithium Toxicity Symptoms
Most of the time, people who experience lithium toxicity experience gastrointestinal (GI) symptoms. They often happen within 1-2 hours after administering too much lithium. Examples include:
- Abdominal pain
- Bloating
- Diarrhea
- Nausea
- Vomiting
People who develop a moderate to severe lithium toxicity may experience neurological symptoms along with gastrointestinal ones. Check some of them below:
- Mild confusion
- Delirium
- Ataxia (coordination and balance problems)
- Tremors (uncontrolled shaking)
- Dysarthria (slurred speech)
- Myoclonus (muscle twitches)
- Seizures
- Coma
- Hyperthermia (low body temperature)
- Hyperreflexia (overactive reflex responses)
- Nystagmus (eye movements that cannot be controlled)
Chronic Lithium Toxicity Symptoms
Those who develop the chronic form of this condition usually experience kidney damage. Furthermore, some people may also experience nephrogenic diabetes insipidus. It happens because the kidneys cannot balance bodily fluids properly. Some symptoms are listed below:
- Dehydration (including dry mouth, extreme tiredness, and dizziness)
- Polyuria (large amounts of urine)
- Polydipsia (excessive thirst)
In some cases, people may also experience sodium-losing nephritis. It happens when kidney damage leads to electrolyte imbalances. Check some symptoms below:
- Muscle cramps
- Weakness
- Polyuria
- Excessive thirst
- Fatigue (extreme tiredness)
- Mental status changes
There is one more condition that may occur due to kidney damage. Usually, people develop it when the kidneys begin to release an excessive amount of protein (proteinuria) in the urine. It is called nephrotic syndrome, and it may cause the following symptoms. For example:
- Appetite changes
- Abdominal pain
- Foamy urine
- Edema in the legs and feet
- Hyperlipidemia (high cholesterol)
Some people with the chronic form of lithium toxicity may also experience problems with the endocrine system and experience the following conditions. Examples include hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), or hyperparathyroidism (overactive parathyroid glands).
Immediately go to the nearest emergency room (ER) or call 911 if any of the previous symptoms occur.
Lithium and Serotonin Syndrome
In some cases, excessive amounts of lithium in the body may cause serotonin syndrome, especially if you are administering medicines that affect your serotonin levels. It is important to know that serotonin syndrome is another life-threatening condition that may cause serious symptoms and complications. Check some symptoms of serotonin syndrome below:
- Diarrhea
- Tremors
- Muscle twitching and rigidity
- Nervousness
- Nausea
- Vomiting
- Dilated pupils
- Sweating
- Shivering
- Fast heart rate
- Hypertension (high blood pressure)
- Agitation
- Restlessness
- Confusion
- Delirium
Causes and Risk Factors
This condition usually occurs when you administer too many medicines that contain lithium, you are dehydrated, or the body cannot process lithium.
Increased Intake of Lithium
People often develop acute or acute-on-chronic toxicity when they accidentally or incidentally take excessive amounts of lithium tablets. In some cases, it may occur when doctors increase the dose too much.
Lithium Excretion Problems
There are some factors that affect the body’s ability to get rid of lithium properly. For example, a lack of sodium (salt) and fluid in the body (dehydration). As a result, the kidneys begin to reabsorb lithium, increasing its concentration in the blood. Check some possible causes of dehydration and a lack of sodium below:
- Fever
- Kidney failure
- Vomiting
- Diarrhea
- Hyperhidrosis (excessive sweating)
- Following a low-sodium diet
- Congestive heart failure
- Performing too much physical exercise
- Diuretics (also known as water pills)
- Hyperthyroidism (overactive thyroid gland)
- Pregnancy or labor and delivery
- Do not drink enough water
While anyone can develop lithium toxicity, physicians have found some factors that could increase your risk. Check some of them below:
- Diabetes insipidus
- Impaired kidney function
- Thyroid disease
- Age – People over 50 years old are more prone to lithium toxicity
- Heavy sweating
- Renal disease
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- ACE inhibitors
What Are The Long-Term Effects of Lithium Toxicity?
People who develop lithium toxicity and do not get treatment may also experience some complications. Check some examples below:
- Non-convulsive seizures
- Coma
- Ataxia
- Slurred speech
- Memory problems
- Chronic movement disorders
- Psychosis
The previous list does not contain all possible lithium toxicity complications. In any case, doctors may recommend ways to reduce the risk or even prevent the previous ones.
How to Prevent Lithium Toxicity?
Usually, doctors recommend following the precautions listed below to reduce the risk of acute lithium toxicity. Examples include:
- Administer medicines exactly as recommended by your doctor
- Store lithium safely
- Drink plenty of water to prevent dehydration
- Always share your medicine list with your doctor
- Inform your doctor about any new or sudden changes to your health (including pregnancy, endocrine changes, and others)
Doctors may also recommend regular blood and urine tests to monitor your health, especially if you administer lithium medicines for long periods. Furthermore, you should call the Suicide and Crisis Lifeline at 988 if you or a loved one has suicidal thoughts.
Diagnosis
Like the diagnosis of many other disorders, the diagnosis of lithium toxicity starts with a physical examination in which doctors will look for abnormalities linked to the disease. They may also ask some questions about your medical history and symptoms to get more clues about your condition. However, to confirm or exclude this disorder, doctors will perform the following tests. These include:
- Blood tests – These tests are done to check lithium levels, measure electrolytes (including sodium and calcium), and measure the thyroid-stimulating hormone (TSH) levels.
- Urinalysis (urine test)
- Kidney function test (such as blood urea nitrogen and creatinine)
- Brain imaging tests
- Electrocardiogram (ECG or EKG) to monitor heart health
Treatment
Doctors usually recommend different treatments for people with lithium toxicity because they depend on several factors. These include the severity and type of the condition, overall health, sex, age, and preferences. Check some common options often recommended by doctors below:
- IV (intravenous) fluids
- Different medicines to relieve symptoms
- Activated charcoal
- Hemodialysis (kidney dialysis)
- Stomach pumping
- Whole-bowel irrigation – During this procedure, doctors clear the gastrointestinal system of lithium.
Frequently Asked Questions
What is the prognosis of lithium toxicity?
Typically, the outlook for people with lithium toxicity varies because it depends on several factors. Examples include the severity of the condition, how fast you get treatment, your response to treatment, and age.
What drug causes lithium toxicity?
There are multiple medicines that can cause this condition. For example, NSAIDs (nonsteroidal anti-inflammatory drugs), ACE inhibitors and ARBs, diuretics, and certain antibiotics. In any case, you should know that this condition may occur if you are dehydrated or have kidney disease that affects the body’s ability to remove lithium properly.
What are the signs of lithium toxicity?
The primary symptoms of this condition are persistent diarrhea and vomiting, hand tremors, and ataxia. If any of them occur without an obvious reason, do not hesitate to see a doctor.
Can lithium toxicity occur even if I take my medication as prescribed?
Yes. Lithium toxicity can develop even when you take your medication exactly as prescribed. Dehydration, kidney problems, interactions with other medications, illness causing vomiting or diarrhea, or sudden changes in sodium intake can all increase lithium levels in the blood.
How often should lithium levels be checked?
The frequency depends on your individual situation. Most healthcare providers recommend checking lithium levels several days after starting treatment or changing the dose, followed by regular monitoring every few months during long-term therapy. Additional testing may be needed if you become ill, start new medications, or develop symptoms of toxicity.
Can dehydration increase the risk of lithium toxicity?
Yes. Dehydration is one of the most common risk factors for lithium toxicity. When your body loses too much fluid through vomiting, diarrhea, fever, heavy sweating, or inadequate water intake, your kidneys retain more lithium, which can cause blood levels to rise to dangerous levels.
Should I stop taking lithium if I think I have symptoms of toxicity?
If you suspect lithium toxicity, contact your healthcare provider or seek emergency medical care immediately. Do not take another dose until you receive medical advice. Because lithium toxicity is a medical emergency, prompt evaluation is essential to prevent serious complications.
Can lithium toxicity cause permanent damage?
In some cases, yes. Severe or untreated lithium toxicity can result in permanent neurological problems, chronic kidney damage, or persistent movement disorders. However, many people recover completely when the condition is recognized early and treated promptly.
What foods or drinks should I avoid while taking lithium?
There are no specific foods that everyone taking lithium must avoid, but it is important to maintain a consistent salt intake and stay well hydrated. Sudden changes in dietary sodium, excessive caffeine consumption, or significant alcohol intake may affect fluid balance and lithium levels. Discuss any major dietary changes with your healthcare provider.
Who is at the highest risk of developing lithium toxicity?
People with chronic kidney disease, older adults, individuals who become dehydrated, those taking medications that interact with lithium (such as certain diuretics, NSAIDs, or ACE inhibitors), and people with conditions that affect fluid or electrolyte balance have a higher risk of developing lithium toxicity. Regular monitoring and following your healthcare provider’s recommendations can significantly reduce this risk. If you have additional questions, ask your healthcare provider.
