Lithium Poisoning

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General Recommendations

  • ECTR is recommended in patients with severe Li poisoning (1D)



ECTR is recommended

  • If kidney function is impaired and the [Li+].>4.0 mEq/L (1D)

  • In the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of [Li+] (1D)


ECTR is suggested

  • if the [Li+].>5.0 mEq/L (2D)

  • If confusion is present (2D)

  • If the expected time to obtain a [Li+]<1.0 mEq/L with optimal management is >36 h (2D)


Cessation of ECTR 

  • When the [Li+] <1.0 mEq/L or clinical improvement is apparent (1D)

  • After a minimum of 6 h of ECTR if the [Li+] is not readily available (1D)


After interruption of ECTR, serial [Li+] measurements should be obtained over 12 h to determine use of subsequent ECTR sessions (1D)


Choice of ECTR

  • Intermittent hemodialysis is the preferred ECTR (1D)

  • Continuous RRT is an acceptable alternative if intermittent hemodialysis is not available (1D)

  • After initial treatment, both continuous RRT and intermittent hemodialysis are equally acceptable (1D)