SAQ 334 – Toxicology – lithium toxicity and mania
Model Answer
Toxicology – lithium toxicity and mania.
a. Mania
- Inflated self-esteem or grandiosity.
- Reduced need for sleep.
- Increased talkativeness.
- Flight of ideas.
- Distractibility.
- Increased goal-directed activity.
- Excessive risky pleasurable activity.
b. Acute overdose
- Predominantly gastrointestinal symptoms with a heavy-metal taste, nausea, vomiting, or diarrhoea.
- Large ingestions, especially over 25 g, can produce moderate to severe gastrointestinal toxicity and occasional neurotoxicity.
c. Chronic toxicity
- Tremor, agitation, hyperreflexia, or ataxia.
- Stupor, rigidity, or hypotension.
- Coma, seizures, or myoclonus in severe poisoning.
- Progressive neurological toxicity is typical of chronic exposure.
d. Predisposing factors
- Reduced renal function.
- Diabetes insipidus or dehydration.
- Sodium depletion.
- Interacting medicines such as NSAIDs, ACE inhibitors, or thiazide diuretics.
e. Enhanced elimination
- Modality: haemodialysis.
- Indications include established neurological toxicity.
- Serum lithium concentration greater than 2.5 mmol/L.
- Renal impairment or inability to clear lithium.
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