Lithium, Elemental

CAS RN: 7439-93-2

Laboratory

A) Obtain a complete blood count in symptomatic patients following an alkaline corrosive ingestion.
B) In patients with signs and symptoms suggesting severe burns, perforation, or bleeding (or adults with deliberate, high volume or high concentration ingestions), obtain renal function tests, serum electrolytes, INR, PTT, type and crossmatch for blood, and monitor urine output. Serum lactate and base deficit may also be useful in these patients.
C) Monitor pulse oximetry or arterial blood gases in patients with signs and symptoms suggestive of upper airway edema or burns.
D) Obtain an upright chest x-ray in patients with signs and symptoms suggesting severe burns, perforation, or bleeding (or adults with deliberate, high volume or high concentration ingestions) to evaluate for pneumomediastinum or free air under the diaphragm. The absence of these findings DOES NOT rule out the possibility of necrosis or perforation of the esophagus or stomach. Obtain a chest radiograph in patients with pulmonary signs or symptoms.
E) Several weeks after ingestion, barium contrast radiographs of the upper GI tract are useful in patients who sustained grade II or III burns, to evaluate for strictures.
A) Monitor vital signs, mental status, and urine output.
B) Serial lithium levels should be followed until concentration has clearly peaked and declined. The correlation between clinical toxicity and serum concentration is poor; an acute overdose is often asymptomatic despite high serum concentration; chronic exposure may have neurologic manifestations at therapeutic concentrations.
C) Monitor electrolytes (particularly sodium), urinalysis, and serum creatinine.
D) Obtain thyroid function tests and arterial blood gases; lithium intoxication may cause a low anion gap.
E) CT scan of brain may be indicated if etiology of altered mentation is in question. Monitor EEG if there is a concern for subclinical seizures. Chest x-ray may be indicated to monitor pulmonary edema. In those with worsening symptoms or known large ingestions, closely monitor airway, breathing, circulation, cardiac ectopy via continuous cardiac monitoring (including pulse oximetry, capnography), and ECGs.
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