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Lithium toxicity — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseLithium toxicitySCE Acute Medicine

A 73-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show ataxia, coarse tremor, renal impairment and lithium 2.9 mmol/L. What is the most appropriate next step in management?

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Correct answer: C — Stop lithium, give intravenous fluids and discuss haemodialysis urgently

The key discriminator is that ataxia, coarse tremor, renal impairment and lithium 2.9 mmol/L, which makes Stop lithium, give intravenous fluids and discuss haemodialysis urgently the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF lithium