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ICU TopicsToxicology

ICU · Toxicology

Lithium Toxicity

Also known as Lithium poisoning · Lithium toxicity · SILENT · Nephrogenic diabetes insipidus lithium · Whole bowel irrigation

The lithium toxicity — the narrow therapeutic index (the therapeutic 0.6 to 1.2 mmol/L), the renal clearance (the handled like the sodium), and the no antidote. The acute overdose (the early GI, the delayed neuro) versus the chronic toxicity (the neuro-dominant, the more dangerous — the tremor, the hyperreflexia, the ataxia, the seizures, the coma, the SILENT). The charcoal the not-bind; the whole-bowel irrigation for the sustained-release; the normal saline (the restore the GFR, the NOT the diuretics); the haemodialysis for the severe (with the rebound).

high10 referencesUpdated 26 July 202627 min readSource-verified · Oct 2026

Checked against its sources on 14 Oct 2026

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Overview & definition

Lithium is a commonly prescribed mood stabiliser for bipolar disorder, with a narrow therapeutic index: maintenance concentrations of 0.6 to 0.8 mmol/L are generally accepted, and some authorities still favour 0.8 to 1.2 mmol/L.[4] It is excreted almost exclusively by the kidney as the free ion, so kidney function governs the risk of toxicity — impaired renal function from volume depletion, intercurrent illness, and drug interactions that reduce lithium clearance all precipitate poisoning.[1] There is no antidote. Toxicity is neuro-dominant — the central nervous system is the primary site of toxicity — and lithium is readily dialyzable.[1]

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References10ShowHide
  1. [1]Baird-Gunning J, Lea-Henry T, Hoegberg LCG, et al. Lithium Poisoning J Intensive Care Med, 2017.PMID 27516079
  2. [2]King JD, Kern MH, Jaar BG Extracorporeal Removal of Poisons and Toxins Clin J Am Soc Nephrol, 2019.PMID 31439539
  3. [3]Decker BS, Goldfarb DS, Dargan PI, et al. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup Clin J Am Soc Nephrol, 2015.PMID 25583292
  4. [4]Grandjean EM, Aubry JM Lithium: updated human knowledge using an evidence-based approach. Part II: Clinical pharmacology and therapeutic monitoring CNS Drugs, 2009.PMID 19374461
  5. [5]Gitlin M Lithium side effects and toxicity: prevalence and management strategies Int J Bipolar Disord, 2016.PMID 27900734
  6. [6]McKnight RF, Adida M, Budge K, et al. Lithium toxicity profile: a systematic review and meta-analysis Lancet, 2012.PMID 22265699
  7. [7]Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients Clin Toxicol (Phila), 2015.PMID 25511637
  8. [8]Bretaudeau Deguigne M, Hamel JF, Boels D, et al. Lithium poisoning: the value of early digestive tract decontamination Clin Toxicol (Phila), 2013.PMID 23566313
  9. [9]Schmidt JJ, Lorenzen J, Chatzikyrkou C, et al. Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication BMC Pharmacol Toxicol, 2014.PMID 25193402
  10. [10]Wijeratne C, Draper B Reformulation of current recommendations for target serum lithium concentration according to clinical indication, age and physical comorbidity Aust N Z J Psychiatry, 2011.PMID 21961481

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