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Abstract
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PURPOSE. Lithium toxicity occurs in two main settings: intentional overdose as part of a suicide attempt, or inadvertently, in the context of acute illness and volume depletion without a change in dose. This study defined the distribution of patients and characteristics of lithium intoxication in each group at two urban teaching hospitals.
MATERIALS AND METHODS. Patients with the diagnostic code for lithium intoxication or overdose were identified over an 12-year period. A chart review was performed to confirm the diagnosis, sort patients according to the mechanism of overdose, collect demographic and clinical data, and assess the clinical outcomes in each episode.
RESULTS. Fifty-six patients with lithium toxicity were identified. Of those, 42 (75%) intentionally overdosed, and 14 (25%) became toxic inadvertently in association with volume depletion. The average lithium dose ingested in the 24 hours prior to the hospitalization was 11,293 mg in the intentional overdose group and 1,363 mg in the inadvertent intoxication group (p = 0.0004). The mean initial lithium level was 2.4 mEq/L in the intentional overdose group and 3.4 in the inadvertent intoxication group (p = 0.003). Forty-five percent of the intentional overdose group developed clinical symptoms of lithium toxicity vs. 100% of the inadvertent intoxication group (p = 0.003). Of the intentional overdose group, 9% required hemodialysis for lithium toxicity vs. 50% of the inadvertent intoxication group (p = 0.004).
CONCLUSION. Patients who develop lithium intoxication inadvertently, in association with volume depletion, have symptoms of lithium toxicity, develop renal failure, and require hemodialysis more frequently than do patients who intentionally overdose on lithium as a suicide attempt, despite having a much lower ingestion of lithium.
Language: en |