Lithium levels and EXTRIP viva

Pattern. Chronic poisoning: maintenance lithium plus a drug interaction and volume depletion. Tissue/brain burden can make neurotoxicity prominent at serum concentrations as low as 1.5 mEq/L.^[1][2]

EXTRIP. Decreased consciousness (drowsiness, falling GCS) is a 1D indication for extracorporeal treatment irrespective of [Li+]. Do not cite a chronic-above-2.5 rule as EXTRIP. Intermittent HD is preferred (1D).^[1]

ED care. Stop lithium and the NSAID (Ragheb: NSAIDs raise serum lithium and cut renal clearance). Intravenous isotonic saline. No charcoal. No sourced urine-output recipe.^[1][3]

After HD. Serial [Li+] over 12 hours. Redistribution rebound at 6–12 hours (about 0.5–1.0 mEq/L) is not typically symptomatic. A single six-hour re-dialysis trigger if above 1.0 with symptoms is not EXTRIP.^[1]