Lithium poisoning: Is the lithium level a guide?

Objective: The aim of the study was to analyze the lithium levels relation with clinical findings and treatment selection in lithium poisonings that were admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU). Methods: The lithium poisoning cases distribution, epidemiologic characteristics, clinical findings, methods of management, length of hospital stay admitted to EMDEU between January 1993 and January 2010 scanned retrospectively from the patient charts. Results: The mean age of the 18 patients diagnosed by lithium poisoning was 34.6 +/- 18.2, female/ male ratio was 2.6. Suicide (50.0%), overdose use (22.2%), accidental (5.6%) and the unknown exposures (11.1%) were the masons of poisonings. Of the eight patients (38.9%) were exposed only lithium, 10 (55.6%) of them were exposed multidrug. The 38.9% (n=7) of the poisoning were chronic, 27.8% (n=5) of them were acute poisonings. Suicide was common under 40 years (chi(2)=8.42, p=0.001). The admission reason in all of patients older than 40 years was chronic poisoning. There were non spesific ST-T alterations in 8 patients (44.4%). Lithium levels were toxic in 14 patients (77.8%). The treatments were gastric layage (GL) and supportive treatment in five patients (27.8%), GL and activated charcoal in two patients (11.1%), hemodialysis and supportive treatment in three patients (16.7%) and only supportive treatment in nine patients (50.0%). Fourteen patients (77.8%) were discharged after observation in emergency service. Although the treatment with hemodialysis and supportive treatment in intensive care, 52 years old man was died. Conclusion: There isn't significant interaction between the lithium levels and clinical findings in every lithium poisoning cases. But older patients have chonic lithium poisonings show frequent neurologic symptoms. Treatment must arrange according to clinical findings besides lithium levels in existence of multidrug use, other diseases and renal function disorders. (Anatolian Journal of Psychiatry 2011; 12:198-203)