![]() Gastrointestinal symptoms such as nausea, vomiting, and diarrhea are the earliest and most common presentation of toxicity.Ĩ Lithium also causes electrocardiographic effects, including bradycardia, T wave flattening or inversion, and QT prolongation. Acute toxicity represents an overdose of lithium in a patient without any lithium body stores. Medications such as nonsteroidal anti-inflammatory drugs, diuretics, and angiotensin-converting enzyme inhibitors may increase lithium levels by interfering with renal lithium elimination.ħ CLINICAL FEATURES Clinical manifestations of lithium poisoning can be classified based on whether the poisoning is due to acute toxicity, chronic toxicity, or acute-on- chronic toxicity. Sustained-release lithium preparations exhibit variable absorption, with a delayed peak of 6 to 12 hours.Ħ Lithium renal elimination is increased by factors that decrease glomerular filtration rate (e.g., dehydration) or sodium concentration (e.g., hyponatremia). Peak plasma concentrations occur 0.5 to 3 hours after a single oral dose, with complete absorption within 8 hours. Lithium increases serotonin release and serotonin receptor sensitivity, and it also inhibits norepinephrine and dopamine release from nerve terminals.ĥ Immediate-release lithium is rapidly absorbed from the gastrointestinal tract. Lithium treatment also appears to substantially decrease the risk of suicide and suicide attempts.Ĥ PRINCIPLES OF DISEASE The precise mechanism of action of lithium as a mood-stabilizing agent is not fully understood. ![]() In 1929, the soft drink “7 Up,” whose original name was “Bib-Label Lithiated Lemon-Lime Soda,” included lithium citrate as an ingredient (until 1950) and was marketed as a patent medicine to cure hangovers.ģ Despite the introduction of newer and safer medications, lithium is established as the most effective long-term treatment to prevent recurrences of mania and bipolar disorder. ![]() 2 PERSPECTIVE Lithium has been used as a medicinal agent since the mid-1800s, when lithium salts were popularized as a treatment for gout (lithium carbonate and lithium citrate), a sedative for manic patients (lithium bromide), and as a treatment for epilepsy (lithium bromide).
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