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Lithium toxicity — SCE Acute Medicine MCQ

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ModerateClinical pharmacology and poisoningLithium toxicitySCE Acute Medicine

A 48-year-old woman with bipolar disorder is admitted with tremor, diarrhoea and confusion after starting ramipril for hypertension. She takes lithium carbonate. Creatinine is 164 micromol/L and lithium concentration is 2.4 mmol/L. ECG is normal and she is haemodynamically stable. What is the most appropriate next step in management?

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Correct answer: C — Stop lithium, give intravenous fluids and discuss urgently with the poisons service/renal team

This is symptomatic lithium toxicity, likely precipitated by ACE inhibitor-associated renal impairment. Management requires stopping lithium, hydration, serial levels and early expert discussion because haemodialysis may be needed depending on symptoms, level and renal function. Activated charcoal does not bind lithium effectively, and sodium bicarbonate is not the core treatment.

Reference: TOXBASE; BNF Lithium