Lithium Toxicity: Role of Hemodialysis

Lithium is one of the most frequently used drugs for treating mood disorders. It is used for both prophylaxis and treatment of bipolar affective disorder. It should be cautiously prescribed and used only when clinically indicated because of narrow therapeutic index and significant toxicity. One of the most alarming and potentially serious complications of lithium carbonate therapy is central nervous system toxicity. It is difficult to recognize early toxicity since signs and symptoms of mild lithium toxicity may be mistaken for other diagnoses. Severe toxicity affects predominantly Central Nervous System and Cardiovascular System and may prove to be fatal. Such cases require early recognition and intervention to prevent any irreversible organ damage or death. Hemodialysis remains the mainstay of treatment in severe lithium toxicity. The decision to start hemodialysis should rely on a combination of clinical features of toxicity, duration of exposure to lithium and serial lithium levels. The current effort is to analyze why lithium toxicity is common, how to recognize it early and intervene in time. Available guidelines for hemodialysis in such cases have been reviewed and discussed.