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Severe lithium toxicity — ACEM Fellowship MCQ

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HardToxicologySevere lithium toxicityACEM Fellowship

A 69-year-old woman presents to a Hobart ED, triage category 2, with tremor, confusion and ataxia after dehydration from gastroenteritis. Lithium level is 3.6 mmol/L, creatinine 240 micromol/L and ECG shows QT prolongation. She has repeated vomiting. What is the most appropriate management?

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Correct answer: C — IV fluids and urgent haemodialysis discussion

High lithium level with renal impairment and neurological toxicity may require dialysis; charcoal does not bind lithium well.

Reference: eTG toxicology; Poisons Information Centre lithium guidance