This handout is for lithium toxicity. Your care team identified this based on: reported acute lithium ingestion (intentional/accidental) — known lithium-treated patient or pill bottle (extrip 2015).
Other reasons your team may use this plan: tremor, ataxia, dysarthria, confusion, myoclonus, or seizure in a patient on chronic lithium (extrip 2015); serum lithium >1.5 meq/l (therapeutic 0.6–1.2) on a routine or screening draw (extrip 2015); nausea, vomiting, diarrhea early after acute ingestion (acute pattern, neuro late) (baird-gunning 2017).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| discontinue lithium + offending nephrotoxic/clearance-reducing meds | — | — | — | EXTRIP 2015 / Baird-Gunning 2017 — removing the source and stopping NSAID/ACEi/ARB/thiazide/metronidazole restores renal lithium clearance; foundational in every pattern |
| isotonic 0.9% sodium chloride resuscitation | 10–20 mL/kg bolus then maintenance titrated to euvolemia + UOP ≥1 mL/kg/h | IV | continuous | Volume repletion + normal saline restores GFR and renal lithium excretion; avoid hypotonic fluids and avoid forced diuresis/diuretics (worsen clearance) |
Plan: Lithium toxicity — stop drug + saline → WBI (SR) → hemodialysis (EXTRIP 2015) → rebound recheck → supportive
Call 911 or go to the nearest emergency room right away if you have:
Psychiatry safety plan + lithium re-initiation decision (consider alternative mood stabilizer if recurrent toxicity); nephrology for nephrogenic DI / chronic interstitial nephropathy; endocrine for hypothyroidism/hyperparathyroidism; SILENT documentation (irreversible cerebellar deficits) + neurology rehab; education on volume/NSAID/sick-day rules (Baird-Gunning 2017)
Guideline: EXTRIP 2015 Lithium Workgroup (Decker et al, Clin J Am Soc Nephrol) + 2024-2025 critical-care toxicology reviews (Baird-Gunning et al; AACT/EAPCCT whole-bowel irrigation position statement)