Abstract
Lithium is worldwide used in treating bipolar disease, but has a narrow therapeutic index (0,8 to 1,2 mmol/L). Long term lithium use may result in a concentrating deficit in the kidneys, volume depletion or decreased renal excretion. Patients with chronic toxicity often present with neurologic findings (sluggishness, ataxia, confusion or agitation, irregular coarse tremors, fasciculations or myoclonic jerks). Severe toxicity may result in seizures, nonconvulsive status epilepticus, and encephalophaty. The syndrome of irreversible lithium effectuated neurotoxicity (SILENT), consists in cerebellar dysfunction, extrapyramidal symptoms, brainstem dysfunction and dementia. These patients are at risk for developing nephrogenic diabetes insipidus (NDI) and hypernatremia. Prolonged QTc intervals, flattened T waves and bradycardia have been reported and danger arrhythmias are rare. The treatment for lithium chronic poisoning includes: fluid therapy (beware of hypernatremia) and hemodialysis (in severe cases).
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