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Lithium toxicity with acute kidney injury — SCE Acute Medicine MCQ

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HardClinical pharmacology and poisoningLithium toxicity with acute kidney injurySCE Acute Medicine

A 58-year-old man taking lithium for bipolar disorder presents with coarse tremor, ataxia, vomiting and confusion after starting an ACE inhibitor and becoming dehydrated. Lithium level is 3.1 mmol/L, creatinine is 232 micromol/L and ECG shows T-wave flattening. What is the most appropriate next step in management?

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Correct answer: A — Stop lithium, give intravenous fluids and discuss haemodialysis urgently with renal and poisons services

Severe lithium toxicity with neurological features and renal impairment requires stopping lithium, volume resuscitation and urgent specialist discussion about haemodialysis. Activated charcoal is ineffective for lithium because it does not bind well. ACE inhibitors, dehydration and AKI are classic precipitants.

Reference: TOXBASE lithium poisoning; BNF lithium