The first sign may be decreased alertness or slight apathy, followed by muscular rigidity or fasciculations and mild ataxia. These symptoms increase and become severe, and then impaired consciousness with a stupor-like presentation can develop.
In mild lithium toxicity, symptoms include weakness, worsening tremor, mild ataxia, poor concentration and diarrhea. With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge (Bauer and Gitlin 2016).
Acute lithium toxicity initially affects fast-acting neurons controlling coordination, resulting in tremor and extremity dyscoordination. Increased toxicity may cause progressive development of slurred speech, muscular fasciculation, seizures, nystagmus, and extrapyramidal features.
Mild symptoms: nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L)[33] [34]. Moderate intoxication: confusion, agitation, delirium, tachycardia, and hypertonia (serum lithium concentration between 2.5-3.5 mEq/L)[33] [34].
SILENT involves the neurological sequelae resulting from acute lithium carbonate intoxication and is less frequent from chronic use, when they persist two months after ceasing treatment. 1,2 Despite of the fact that lithium is still widely used today, SILENT is an uncommon entity.
To prevent SILENT, it may be helpful to avoid high lithium levels through regular and frequent monitoring (eg, every 4-6 months). If symptoms develop, rapidly taper and discontinue lithium.
Risk factors for lithium toxicity include age older than 50 years, abnormal thyroid function, and impaired renal function. Long-term lithium use increases the risk of lithium-induced nephrogenic diabetes insipidus, which causes loss of renal urine-concentrating ability and increased risk of lithium intoxication.
Acute toxicity often causes immediate gastrointestinal symptoms, while other symptoms tend to develop over several hours as lithium moves into tissues and cells without prior lithium stores.
The most commonly prescribed drugs that have the potential to interact with lithium are ACE inhibitors, angiotensin II receptor antagonists (sartans), diuretics, and non-steroidal anti-inflammatory drugs (NSAIDs).
Lithium may cause problems with kidney health. Kidney damage due to lithium may include acute (sudden) or chronic (long-term) kidney disease and kidney cysts.
Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild.
Some side effects are common when people first start lithium, such as: Tremors (shakiness), especially in the hands. Dry mouth. Feeling thirstier.
Adverse effects were the most common cause for lithium discontinuation. Among the adverse effects, diarrhoea, tremor, creatinine increase, polyuria/polydipsia/diabetes insipidus and weight gain were the top five reasons for discontinuing lithium.
► Exposure to Lithium can cause loss of appetite, nausea, vomiting, diarrhea and abdominal pain. ► Lithium can cause headache, muscle weakness, twitching, blurred vision, loss of coordination, tremors, confusion, seizures and coma.
The most common side effects of lithium are feeling or being sick, diarrhoea, a dry mouth and a metallic taste in the mouth. Your doctor will carry out regular blood tests to check how much lithium is in your blood.
The amount of water in the body affects blood lithium levels. Too little water (dehydration) can lead to high, or even toxic lithium levels So it's important to drink plenty of water while taking lithium. Diarrhea, vomiting, and excessive exercise or sweating can also dehydrate you.
The syndrome of irreversible lithium effectuated neurotoxicity (SILENT) is characterized by cerebellar dysfunction, extrapyramidal symptoms, brainstem dysfunction, and dementia. Other symptoms can include nystagmus, choreoathetoid movements, myopathy, and blindness.
In early lithium toxicity, you may have mild confusion. As the toxicity worsens, you may feel delirious or even have seizures or go into a coma. In very rare cases, lithium toxicity may cause diabetes insipidus. This condition leads to large amounts of urine in your body, regardless of how much fluid you drink.
Sodium administration, and the maintenance of high-normal sodium levels, may also reduce the severity of lithium toxicity by removing the dangerous intracellular fraction of lithium from inside excitable cells.
Urinalysis, electrolyte levels, and kidney function should also be checked. A low anion gap (see the Anion Gap calculator) or a low urine specific gravity may suggest lithium toxicity due to sodium loss. A thyroid function panel may also be considered in patients presenting with symptoms suggestive of hypothyroidism.
Carbamazepine, phenytoin, and methyldopa may increase the toxicity of lithium.
Lithium is a mood stabilising medicine used to treat certain mental illnesses, such as: mania (feeling highly excited, overactive or distracted) hypomania (like mania, but less severe) bipolar disorder, where your mood changes between feeling very high (mania) and very low (depression)
The main problems associated with long-term lithium treatment include kidney, thyroid, and probably cognitive issues.