Posted by Sunnely on August 19, 2000, at 12:43:33
In reply to OVERDOSE ON LITHIUM, posted by Katey on August 19, 2000, at 1:22:10
> Recently, my aunt overdosed on lithium. The doctors told us that your Li blood level is suposed to be between a .5 & 1. Her level when they brought her in was a 9.
Hi Katey,
First, I am sorry to hear about your aunt's serious condition. I hope that she overcomes this and returns to her former health.
Lithium level of 0.5 to 1.0 (0.8 to 1.2) is the generally accepted therapeutic level. However, this is not etched in stone. Some people such as the elderly and those with concurrent neurological conditions are more sensitive to lithium toxicity and therefore, require lower lithium levels for stabilization. FYI, it is the clinical signs and symptoms that dictate severity of lithium toxicity and the decision to lower the dose or stop lithium treatment. In short, the clinical picture is primary, lithium level is secondary.
Lithium level of 9 is an extremely high level. In fact, I would consider it beyond the extreme (4.0 - 7.0). Chances of survival or returning to former health after a massive lithium overdose depends on several factors which may include but not limted to: 1) the lapse of time between the overdose and medical intervention, 2) the amount of drug taken, 3) the blood level of lithium, 4) person's overall health status, 5) state of hydration, 6) co-existing neurological conditions, 7) concomitant medications, 8) age, 9) coexisting alcohol problem, 10) idiosyncrasies (individual differences).
If your aunt survives this condition, I sincerely hope that she does not experience permanent residual effects from the lithium overdose. I don't want to sound harsh or uncaring, but irreversible brain damage with residual neurological effects have been reported in cases of lithium overdose. My intention is to inform you of these potential residual effects so that you will be more emotionally prepared to cope with them in case they develop.
Most of the irreversible effects from lithium overdose are centered on the cerebellar functions. These symptoms may include gait and sitting ataxia (unsteadiness while walking and sitting), which are common; clumsiness of motor movement, resulting from inability to control accurately the range and precision of movement; difficulty articulating with scanning or slurring of speech; dysdiadochokinesis is common (performance of rapid alternating movements of the limbs is jerky and uncoordinated). Other residual effects include neuropathy (nerve pain); hyperactive reflexes; increased depression; and intermittent convulsions.
The treatment of choice in lithium overdose with high lithium levels or worsening clinical symptoms is hemodialysis. It should be instituted as soon as possible or in the first 8-12 hours, based on the clinical condition of the person and blood lithium level. Hemodialysis removes the lithium from the blood, but transfer between intracellular (inside blood cells) and extracellular (outside blood cells) compartments is slow. Therefore, return of blood lithium level to normal may not be mirrored by lowering of intracellular lithium concentrations to safe levels. Frequent monitoring of blood lithium levels and prolonged hemodialysis have been suggested to prevent the permanent toxic effects of lithium overdose. Blood level of lithium can decrease by half every 1 or 2 days. Nevertheless, neurologic symptoms may persist or worsen even after the blood level has decreased. Presumably brain levels of lithium drop more slowly.
If symptoms of brain damage occur and persist, physical therapy, general rehabilitation, speech therapy, and other supportive therapies are helpful. Improvement can continue over the first 6-12 months although speech problems lessen more than does the unsteadiness of body and limbs.
Again, hoping the best for you and your aunt.
Reference:
Irreversible lithium neurotoxicity: An overview. Clinical Neuropsychopharmacology 1997;20:283-299.
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