Poisoning with lithium

Ayd FJ. Acute self poisoning with lithium. Int Drug TherNews11988 23 1-2. 

There seems no reason, therefore, to eschew the description of lithium therapy as the treatment of manic patients by lithium poisoning, in the words of an early critic (Wikler 1957). Anticonvulsants do not share the toxicity profile of lithium, but by virtue of their use to prevent epileptic fits, they all exert depressant effects on the activity of the central nervous system. With this profile of drug-induced effects in mind, let us examine the research on whether lithium or other drugs currently used in manic depression act in a disease-centred way and consider whether they have any real benefits. 

Hypernatremia can occur secondary to dehydration in patients taking lithium and is not uncommon in association with lithium poisoning. Lithium-induced diabetes insipidus is often a contributing factor. 

Hemodialysis (383,552,553), sometimes with additional continuous venovenous hemofiltration dialysis (554,555), continues to be described as a successful intervention for lithium poisoning. Peritoneal dialysis is a far less efficient way to clear lithium from the body. One patient treated in this way had permanent neurological abnormalities and another died a third toxic patient who also had diabetic ketoacidosis died after treatment with hydration and insulin (556). On the other hand, a 51-year-old woman who took 50 slow-release lithium carbonate tablets (450 mg) had a serum lithium concentration of 10.6 mmol/1 13 hours later, but no evidence of neurotoxicity or nephrotoxicity. She was treated conservatively with intravenous fluids and recovered fully (557). Acute lithium overdose is often better tolerated than chronic intoxication. 

Ochoa ER, Farrar HC, Shirm SW. Lithium poisoning in a toddler with fever and altered consciousness. Case presentation and discussion. J Invest Med 2000 48 612. 

Chemical properties.—Sodium chloride is necessaiy for the proper performance of the physiological functions of the body the other alkali chlorides are said to be poisonous with small animals. According to C. Richet, the maximum dose per kilogram of animal, with subcutaneous injections, is OT grm. with lithium chloride 0 5 grm. with potassium chloride 1 0 grm. with rubidium chloride and 0 5 grm. with caesium chloride. Lithium chloride is very hygroscopic sodium chloride is less hygroscopic, but it takes up 0 5 to 0 6 per cent, moisture on exposure... 

Table 2. Clinical symptomatology associated with lithium poisoning.

The technicians have always been well aware of the problems not only in finding a suitable positive electrode, but also in dealing with this available and therefore not-too-precious element. Lithium reacts with humidity, especially with water, and has its melting point at 180°C. Apart from this, the fact that perchlorates and hydrides of hthium are poisonous and must be coped with. 

Contraindications Intestinal obstruction, GI tract not anatomically intact patients at risk of hemorrhage or GI perforation, if use would increase risk and severity of aspiration not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol poisoning, lithium do not use charcoal with sorbitol in patients with fructose intolerance, hypersensitivity to charcoal or any component of the formulation... 

When a specific antidote or other treatment is under consideration, quantitative laboratory testing may be indicated. For example, determination of the acetaminophen serum level is useful in assessing the need for antidotal therapy with acetylcysteine. Serum levels of salicylate (aspirin), ethylene glycol, methanol, theophylline, carbamazepine, lithium, valproic acid, and other drugs and poisons may indicate the need for hemodialysis (Table 58-3). 

The 13C n.m.r. spectra of nicotine metabolites have been measured and discussed.39 The stereoselectivity of the iodomethylation of nicotine and seven analogues has been studied with the aid of 13C n.m.r. spectroscopy.40 Nicotine yields 2-methylnicotine as the major product when treated with methyl-lithium or methyl radicals, accompanied, as reported earlier, by 4- and 6-methylnicotine. Nicotine tV-oxide and methylmagnesium bromide afford 2- and 6-methyl-nicotines.41 Anabaseine (26), a well-known minor alkaloid of tobacco, has been identified as a poison-gland product in ants of the genus Aphaenogaster, which use it as an attractant.42... 

Lithium is a highly neurotoxic substance with a generally suppressive effect on neuronal function and mental function in the commonly prescribed therapeutic range. It is poisonous to brain cells. The much-promoted concept that lithium and other mood stabilizers are somehow protective of brain cells is fantastical. 

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