Management overview for chronic lithium accumulation

This monograph discusses the management of toxicity due to chronic lithium accumulation. For management of acute lithium poisoning, see here. Poisoning due to acute-on-chronic ingestion of lithium is managed as for acute lithium poisoning.

Patients taking long-term lithium therapy can develop chronic toxicity if:

• their usual dose is increased
• they are prescribed additional medications
• elimination of lithium is reduced due to kidney impairment
• they develop lithium-induced nephrogenic diabetes insipidus and subsequent irreversible kidney injury.

Chronic lithium toxicity has a more insidious onset than acute lithium poisoning and is associated with significant morbidity and mortality. It commonly presents with neurological manifestations, which can take days to weeks to resolve. Recovery is significantly delayed even when the serum lithium concentration has decreased to a subtherapeutic concentration.

Management of chronic lithium toxicity aims to prevent permanent neurological sequelae and kidney failure, and often involves intravenous fluid therapy. Withhold all nephrotoxic agents, including lithium. Haemodialysis may be required.