Antidote for lithium9/7/2023 ![]() ![]() Coarse tremors, seizures, fasciculations, myoclonic jerks ,.Delirium, encephalopathy, psychomotor impairment.Further fluid loss may exacerbate lithium toxicity.Other medications: tetracyclines, cyclosporines, metronidazole.Medications that can precipitate lithium toxicity by increasing renal absorption of lithium:.Low effective circulating volume (e.g., due to dehydration, loop diuretic use, cirrhosis, congestive heart failure ).Increase in dosage (lithium has a narrow therapeutic window).Toxicity occurs at serum levels > 1.5 mEq/L. Often occurs in the setting of nephrogenic DI.Risk correlates with the cumulative dose and duration of lithium use.Interstitial fibrosis, focal nephron atrophy, tubular cysts with chronic use. ![]() Chronic interstitial nephritis ( lithium-associated nephropathy).Clinical features: polyuria, nocturia, and polydipsia → ↑ risk of dehydrationand subsequent lithium toxicity.Pathophysiology: lithium interferes with ADH signaling → ↓ aquaporins (water channels) on the collecting duct cell's surface → ↓ water molecules are reabsorbed and kidneys are unable to concentrate urine → ↑ free water excretion.Goiter (particularly in second and third trimester of pregnancy ).Caused by the elevation of the calcium-sensing setpoint of the parathyroid glands and induction of parathyroid hormone production.Sinus node dysfunction (most commonly sinus bradycardia).ECG changes: T-wave depressions (most common), U waves, repolarization abnormalities.Often decreases spontaneously over time.Typically occurs when lithium therapy is started or the dose is increased but can occur at any time during the course of treatment.Nonprogessive, s ymmetric, fine postural tremor in the distal ends of upper extremities.Adverse effects occur at therapeutic levels ( 0.4–1.0 mEq/L) but tend to be more severe at peak serum concentration of the drug. ![]()
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