lithium toxicity

 Q: EKG changes in lithium toxicity can be fatal? 

A) True

B) False

Answer: B

Despite EKG changes, cardiac events are rare in acute or chronic lithium toxicity. It is actually neurological symptoms that are more worrisome. Common EKG findings are bradycardia with flattened T waves and prolonged QTc intervals. 

Acute lithium toxicity causes nausea, vomiting, and diarrhea. Hydration in this phase is of clinical importance as dehydration can exacerbate lithium toxicity and lead to acute kidney failure. 

Neurologic findings imply a late phase of toxicity. It may cause confusion, agitation, tremors, fasciculations, myoclonic jerks, and seizures. Hemodialysis is indicated.

#toxicology

References:

1. Demers RG, Heninger GR. Electrocardiographic T-wave changes during lithium carbonate treatment. JAMA 1971; 218:381. 

2. Offerman SR, Alsop JA, Lee J, Holmes JF. Hospitalized lithium overdose cases reported to the California Poison Control System. Clin Toxicol (Phila) 2010; 48:443. 

3. Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28:38. 

4. Rose SR, Klein-Schwartz W, Oderda GM, et al. Lithium intoxication with acute renal failure and death. Drug Intell Clin Pharm 1988; 22:691.