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The clinical characteristics and correlates of lithium toxicity in a tertiary referral centre

  • Niamh M. GanterEmail author
  • Kezanne Tong
  • Colm McDonald
  • Anne M. Doherty
Original Article

Abstract

Introduction

Lithium is a medication indicated for the treatment of bipolar disorder and treatment-resistant depression, with a narrow therapeutic index. Overdose, either acute or chronic can result in neurological symptoms, requiring dialysis and admission to intensive care in some cases. Lithium toxicity is avoidable with careful monitoring. However, we have noted several recent cases of lithium toxicity in our local service and thus sought to investigate this issue in a more systematic manner.

Aim

We aimed to quantify the incidence of lithium toxicity in our local population over a single year and identify the patients most at risk. We also aimed to generate clinical recommendations on the prevention of lithium toxicity to improve patient safety.

Method

We identified the incidence of lithium toxicity in our local population, by searching the hospital pathology database for patients with serum lithium levels greater than 1.0 mmol/L. We examined the available clinical notes for these patients.

Results

We identified 74 serum lithium readings above 1.0 mmol/L measured in 44 individual patients. The highest recorded level was 3.2 mmol/L. Of these, 11 patients were aged 65 years or older. Hospital admission was required in 14 cases. There were missing data of note: 29.5% had no renal function/eGFR measurement at time of toxicity and 52.3% without a baseline eGFR.

Conclusion

Lithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over.

Keywords

Clinical Galway Lithium Monitoring Overdose Tertiary Toxicity Toxicology 

Notes

Funding information

Grant supplied by Undergraduate Research Committee, School of Medicine, National University of Ireland, Galway.

Compliance with ethical standards

Ethical disclosure statement

For this project, we sought quality and integrity. We were in contact with no patients for the duration of the study. No identifiable patient data was used. Data was obtained via an electronic hospital laboratory system and was anonymised to ensure patient confidentiality. Data was stored on a fire-walled computer with coded access. Funding was obtained from the undergraduate research program at NUI Galway.

Conflict of interest

No conflicts of interest existed in relation to this.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Niamh M. Ganter
    • 1
    Email author
  • Kezanne Tong
    • 2
  • Colm McDonald
    • 1
    • 2
  • Anne M. Doherty
    • 2
  1. 1.School of MedicineNational University of IrelandGalwayIreland
  2. 2.Department of PsychiatryUniversity Hospital GalwayGalwayIreland

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