Lithium side effects and signs of toxicity

Expected Side Effects (therapeutic level)

0.4-1.0 mEqL Fine hand tremor, polyuria, and mild thirst. Mild nausea and general discomfort. Weight gain. Symptoms may persist throughout therapy. Symptoms often subside during treatment. Weight gain may be helped with diet, exercise, and nutritional management

Early signs of toxicity

1.5 mEq/L Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle wearkness, and fine hand tremor Medication should be withheld, blood lithium levels measured, and dosage reevaluated

Advanced signs of toxicity

1.5-2.0 mEq/L Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination, sedation interventions depend on severity of circumstances... Medication should be withheld, blood lithium levels measured, and dosage reevaluated hospitalization is indicated. The drug is stopped, and excretion is hastened. If patient is alert, an emetic is administered

Severe toxicity

2.0-2.5 mEq/L ataxia, giddiness, serious electroencephalographic changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma. death is usually secondary to pulmonary complications hospitalization is indicated. The drug is stopped, and excretion is hastened. If patient is alert, an emetic is administered >2.5 mEq/L- convulsions, oliguria, and death can occur. in addition to the interventions above, hemodialysis may be used in severe cases