Table of contents
Lithium toxicity
What's new
Added EXTRIP, NICE, BAP and RANZCP guidelines for the screening and management of lithium toxicity.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of lithium toxicity are prepared by our editorial team based on guidelines from the Royal Australian and New Zealand College of Psychiatrists (RANZCP 2017), the British Association for Psychopharmacology (BAP 2016), the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP 2015), and the National Institute for Health and Care Excellence (NICE 2014)....
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Screening and diagnosis
Clinical monitoring of patients taking lithium: as per NICE 2014 guidelines, Monitor patients taking lithium at every appointment for symptoms of neurotoxicity, including paresthesia, ataxia, tremor and cognitive impairment. Recognize that these complications can occur at therapeutic levels of lithium.
E
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Laboratory monitoring of patients taking lithium
Therapeutic procedures
ECTR, indications for initiation
As per EXTRIP 2015 guidelines:
Initiate ECTR in patients with severe lithium poisoning, as defined by any of the following:
impaired kidney function and serum lithium level of > 4.0 mEq/L
decreased level of consciousness, seizures or life-threatening dysrhythmias, irrespective of the serum lithium level
B
Consider initiating ECTR in patients with:
serum lithium level of > 5.0 mEq/L
significant confusion
an expected time to reduce serum lithium level to < 1.0 mEq/L with optimal management of > 36 hours
C
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ECTR (choice of technique)
ECTR (indications for discontinuation)