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Lithium toxicity — RCPSC EM MCQ

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HardToxicologyLithium toxicityRCPSC EM

A 58-year-old woman on chronic lithium presents with tremor, ataxia, vomiting, confusion, and dehydration after starting an ACE inhibitor. Creatinine is 210 µmol/L and lithium level is 3.8 mmol/L. What is the most appropriate disposition?

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Correct answer: B — ICU/nephrology admission for haemodialysis assessment

Severe lithium toxicity with neurologic findings, renal impairment, and a high level requires admission and urgent nephrology/toxicology assessment for haemodialysis. Charcoal does not bind lithium.

Reference: Ontario Poison Centre guidance; EXTRIP recommendations