Normal Renal Handling of Lithium
Placeholder: kidneys filter and reabsorb lithium alongside sodium normally.
- 0.6–1.2: Therapeutic range (mmol/L placeholder)
- ~20%: Renal clearance (of GFR, placeholder)
- ~24h: Half-life (placeholder value)
- Proximal tubule: Reabsorption site (placeholder note)
How lithium is normally cleared
Placeholder: lithium follows sodium reabsorption in the proximal tubule.
NSAIDs and Diuretics Reduce Lithium Clearance
Placeholder: NSAIDs and thiazides both raise serum lithium levels.
- +25–40%: NSAID effect (placeholder rise)
- +40–50%: Thiazide effect (placeholder rise)
- Days: Onset (placeholder timeframe)
- ↓ Clearance: Mechanism (placeholder note)
Why these drugs raise lithium
Placeholder: reduced renal prostaglandins and sodium loss increase reabsorption.
Volume Depletion Concentrates Serum Lithium
Placeholder: dehydration shrinks volume of distribution, raising concentration.
- +30–50%: Fluid loss effect (placeholder rise)
- Vomiting, heat: Common causes (placeholder list)
- Increases Li uptake: Compensatory Na loss (placeholder note)
- Elderly: Risk group (placeholder note)
Dehydration and lithium concentration
Placeholder: less body water means the same lithium dose reads higher.
Crossing Into the Toxic Range
Placeholder: combined factors push serum lithium above 1.5 mmol/L.
- 1.5–2.5: Mild toxicity (mmol/L placeholder)
- >2.5: Severe toxicity (mmol/L placeholder)
- Serum levels: Monitoring (placeholder note)
- Hold dose: Action threshold (placeholder note)
Recognizing rising toxic levels
Placeholder: serial serum measurements catch the climb before symptoms peak.
Neurotoxic Symptom Escalation
Placeholder: tremor progresses to confusion and then seizure.
- Fine tremor: Early sign (placeholder note)
- Confusion: Moderate sign (placeholder note)
- Seizure/coma: Severe sign (placeholder note)
- Dialysis: Treatment (placeholder note)
From tremor to seizure
Placeholder: symptom severity tracks serum lithium concentration closely.
Placeholder: severe toxicity is a medical emergency requiring hemodialysis.