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Current Medical Issues
By Hazaa Humaid Mohammed Alghafri, Nawaf Mohammed Abdullah Al Hatmi, Darpanarayan Hazra and 1 others.
Abstract Background: Lithium is a cornerstone treatment for bipolar disorder, but its narrow therapeutic index makes toxicity clinically important. This study described the presentation, management, and outcomes of lithium toxicity at a tertiary academic hospital.
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This retrospective observational study included all patients who underwent serum lithium testing between January 1, 2011 and January 1, 2023. Patients with serum lithium concentrations ≥1.2 mmol/L and/or clinical features consistent with lithium toxicity while receiving lithium therapy were included and analyzed.
During the study period, 293 patients underwent serum lithium testing, of whom 38 (13.0%) met criteria. Among these cases, 26 (68.4%; 8.9% of all tested patients) had acute overdose-related toxicity, and 12 (31.6%; 4.1% of all tested patients) had chronic toxicity. The mean age was 37.9 ± 9.9 years, and 68.4% were female. Neurological manifestations were the most common presentation, particularly tremor and confusion, followed by gastrointestinal symptoms. Based on serum lithium concentrations together with clinical manifestations, 19 (50.0%) patients had mild toxicity, 15 (39.5%) had moderate toxicity, and 4 (10.5%) had severe toxicity. Mild and severe toxicity occurred exclusively in acute cases, whereas all chronic cases were classified as moderate. Elevated serum creatinine was observed in 31.6% of patients. Most patients were managed conservatively with intravenous saline, and only 1 (2.6%) patient required hemodialysis. Twenty-six (68.4%) patients were discharged from the emergency department, and 12 (31.6%) required hospital admission. No deaths occurred.
In this single-center cohort, lithium toxicity was characterized mainly by neurological manifestations and generally favorable short-term outcomes with supportive treatment.
Published in Current Medical Issues. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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