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Lithium

المؤلف:  Sue Jickells , Adam Negrusz (Editors)

المصدر:  Clarkes Analytical Forensic Toxicology

الجزء والصفحة:  p107-108

2026-09-23

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Lithium

Lithium salts are used in the prophylaxis of manic-depressive (bipolar) psychiatric disorders. These are usually prepared from lithium carbonate or citrate, and most are in the form of sustained-release preparations. The drug is well absorbed from the gut, with peak plasma lithium concentrations observed within 2 h for instant release preparations and 2.5–5 h for sustained release formulations. Lithium is not bound to plasma proteins and is eliminated only via the kidney. Plasma concentrations can accumulate to toxic levels if renal impairment develops. It is recommended that patients who receive therapy with lithium have regular monitoring to maintain plasma lithium concentrations in the therapeutic range. Nevertheless, overdosage with lithium, either acute, acute on chronic, or chronic is relatively common (Bailey and McGuigan 2000). Signs and symptoms of toxicity include ataxia, tremor, dysarthria, slurred speech, drowsiness and coma. The toxicity of lithium is exacerbated in cases in which there has been sodium depletion, through vomiting, and may sometimes be associated with the concurrent use of diuretic drugs. The therapeutic and toxic range in terms of plasma and serum values are rather close. Recommended therapeutic concentrations of lithium in plasma or serum are 0.6–1.2 mmol/L and may be associated with side-effects such as gastrointestinal upset, polyuria, thirst and fatigue. Signs and symptoms of toxicity are generally associated with values >1.5 mmol/L, and values >2 mmol/L require urgent medical attention.