Overview
Introduction
Lithium toxicity is a clearance problem with a narrow safety margin.
Lithium toxicity is a clearance problem with a narrow safety margin. The prescribed dose may be unchanged while vomiting, diarrhea, sweating, reduced intake, a low-sodium diet, declining kidney function, or a new interacting drug causes the serum lithium concentration to rise. Early clues are often gastrointestinal or neurologic rather than a dramatic change in vital signs. The RN’s pattern is a new symptom or change from baseline in a patient taking lithium plus a possible fluid, sodium, renal, or medication trigger. Do not wait for a severe level or seizure before acting: withhold lithium, obtain an urgent level, support renal clearance with isotonic saline as ordered or directed by protocol, and escalate for neurologic deterioration or impaired clearance.