Lithium, Elemental

CAS RN: 7439-93-2

Range of Toxicity

A) LIQUID CORROSIVES - With highly concentrated liquids (30% sodium hydroxide) esophageal burns may occur in up to 100% of patients, even after accidental ingestion.
B) Serious burns are less likely if the pH is less than 11.5. Injury is greater with large exposures and high concentrations.
C) More recent series of caustic ingestions (mixed liquid and solid) in children report incidences of significant esophageal burns from 5% to 35%. Adults with deliberate ingestions are more likely to develop significant esophageal burns (30% to 80%).
D) LOW PHOSPHATE DETERGENTS and electric dishwasher soaps may result in oral and esophageal burns.
A) TOXICITY: Toxic dose is not well defined. In some patients on chronic lithium therapy, the serum concentrations associated with toxic effects are close to therapeutic levels. Therapeutic concentration is 0.6 to 1.2 mEq/L. CHRONIC VS ACUTE: Acute poisoning is typically less severe than chronic for a given serum concentration. Mild to moderate toxic reactions may occur at 1.2 to 2.5 mEq/L in chronic intoxications. Patients with chronic toxicity and serum concentrations above 2.5 mEq/L may have more severe effects, and serum concentrations above 4 mEq/L are generally associated with severe CNS effects in patients with chronic toxicity. Patients with an acute lithium toxicity can develop high serum concentrations with limited distribution to the brain (which can be delayed up to 24 hours), and limited neurologic toxicity. Conversely, in patients on chronic therapy the serum lithium concentration is closer to steady state and correlates better with brain lithium levels.
B) ADULTS: A 45-year-old man died after an acute ingestion of 90 sustained-release lithium tablets (450 mg each) with a peak level of 6.9 mEq/L despite hemodialysis. A 28-year-old man survived an acute ingestion with a lithium level of 10 mEq/L. An adult recovered after an acute ingestion of 84 grams (210 tablets of 400 mg) of lithium. Levels up to 14 mmol/L have been recorded in survivors of acute ingestions. PEDIATRIC: Accidental ingestions of an average of 2 pills typically causes drowsiness, while neurotoxicity has resulted after chronic therapy of 40 mg/kg/day. Mortality due to lithium as a single exposure is rare if recognized quickly and treated aggressively.
C) Full recovery was reported after a 39-year-old man ingested 210 lithium carbonate tablets (400 mg each) following a suicide attempt.
D) THERAPEUTIC DOSE: ADULT: Daily dose ranges from 600 to 2400 mg. PEDIATRIC: EXTENDED-RELEASE TABLETS: 12 YEARS OF AGE AND OLDER: The recommended dose is 900 to 1800 mg/day orally in 2 to 4 divided doses. IMMEDIATE-RELEASE AND CAPSULES: 12 YEARS OF AGE AND OLDER: maintenance, 300 mg orally 3 to 4 times daily; desired serum lithium levels ranging between 0.6 to 1.2 mEq/L. YOUNGER THAN 12 YEARS OF AGE: Safety and effectiveness have not been established.
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