Vomiting lithium

Lithium carbonate is rapidly absorbed after oral administration. The most common adverse reactions include tremors, nausea, vomiting, thirst, and polyuria Toxic reactions may be seen when serum lithium levels are greater than 1.5 mEq/L (Table 32-1). Because some of these toxic reactions are potentially serious, lithium blood levels are usually obtained during therapy, and the dosage of lithium is adjusted according to the results. 

Remember to take lithium with food or immediately after meals to avoid stomach upset. Drink at least 10 large glasses of fluid each day and add extra salt to food. Prolonged exposure to the sun may lead to dehydration. If any of the following occurs, do not take the next dose and immediately notify the primary health care provider diarrhea, vomiting, fever, tremors, drowsiness, lack of muscle coordination, or muscle weakness. 

Metronidazole Nausea/vomiting Metallic taste Refrain from using alcoholic beverages potential for disulfiram-like reaction Substrate for CYP2C9 and inhibitor of CYP2C9, 3A3/4 and 3A5-7 potential interactions may include warfarin (enhanced prothrombin time) and lithium (increased concentrations)... 

Lithium toxicity can occur with serum levels greater than 1.5 mEq/L, but the elderly may have toxic symptoms at therapeutic levels. Severe toxic symptoms may occur with serum concentrations above 2 mEq/L, including vomiting, diarrhea, incontinence, incoordination, impaired cognition, arrhythmias, and seizures. Permanent neurologic impairment and kidney damage may occur as a result of toxicity. 

Several factors predispose to lithium toxicity, including sodium restriction, dehydration, vomiting, diarrhea, drug interactions that decrease lithium clearance, heavy exercise, sauna baths, hot weather, and fever. Patients should be told to maintain adequate sodium and fluid intake and to avoid excessive coffee, tea, cola, and other caffeine-containing beverages and alcohol. 

Lithium toxicity can occur as a result of intentional overdose therefore, care must be taken when administering lithium to potentially suicidal patients with BPAD. Inadvertent lithium toxicity may also occur. For example, diuretics and nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) slow the excretion of lithium and can lead to accidental toxicity. Consequently, the patient should be advised not to take such commonly available medications while treated with lithium. In addition, dehydration resulting from varied causes such as diarrhea, vomiting, and profuse sweating can lead to accidental lithium toxicity. One should advise the patient who takes lithium to be careful to remain well hydrated at all times and to contact his/her physician if any medical condition arises that may cause rapid fluid losses (e.g., stomach virus, high fevers). 

Outside its therapeutic range, lithium has a wide range of undesirable effects. Nervous system-related effects include tremor, difficulty walking, seizures, slurred speech, and mental confusion. In addition there can be cardiovascular effects, nausea, vomiting, and kidney damage. 

Adverse reactions that are not dose dependent are nausea, vomiting and diarrhoea. Lithium has a low therapeutic index. Some adverse reactions such as thirst and mild polyuria may occur at therapeutic plasma concentrations of 0.4-1.0 mEq/1. At concentrations of 1.0-1.6 mEq/1 diarrhea, nausea and incoordination become prominent. At toxic levels ataxia, confusion and stupor occur potentially leading to coma and death. 

A 51-year-old man who had taken lithium for over 10 years presented with nausea, vomiting, anorexia, hypercalcemia (3.1 mmol/1), and increased PTH concentration (iPTH 110 ng/1). Abnormalities resolved after an oxyphilic parathyroid adenoma was excised (667). 

Initially, when the maintenance dose of lithium is being established, the patient may experience gastrointestinal discomforts such as nausea, vomiting, diarrhea, stomach pain, muscular weakness, unusual thirst, frequent urination, a slight feeling of being dazed, tiredness, and sleepiness. These early side effects disappear once the patient is stabilized. 

Lithium Carbonate Common symptoms of lithium toxicity are nausea, vomiting, and diarrhea followed by tremor, increased muscle tone, and rigidity. Acute kidney problems and nephrogenic diabetes insipidus may be possible hazards. In serious cases, coma and convulsions can be observed along with toxicity. 

Lithium can cause loss of appetite, nausea, and at times vomiting and loose stools, especially early in therapy, but these can be minimized by the passage of time and by... 

A 72-year-old man who had recently started to take lithium developed severe nausea, vomiting, and oliguric renal insufficiency which was initially attributed to lithium toxicity, until a serum lithium concentration of only 0.35 mmol/1 directed evaluation to the correct diagnosis of acute gastric volvulus (354). 

An 80-year-old woman taking lithium developed constipation, nausea, vomiting, and abdominal pain after starting to take amfebutamone. A diagnosis of acute paralytic ileus was made and attributed to amfebutamone, although an amfebutamone-lithium interaction could not be excluded (355). 

Factors that put patients at risk of lithium intoxication are those that increase intake (deliberately or accidentally), reduce excretion (kidney disease, dehydration, low sodium intake, drug interactions), or reduce body water (dehydration secondary to fluid restriction, vomiting, diarrhea, or polyuria) (66). Patients with lithium-induced polyuria are at a particular risk of toxicity if their ability to replace fluids is compromised (for example by anesthesia, over-sedation, CNS trauma). 

The point of this case is that lithium toxicity can occur in a patient who has been taking a stable lithium dose during an episode that can be associated with nausea, vomiting, and diarrhea, which could reduce lithium excretion. 

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