All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas, and we're going to talk about lithium toxicity.

Josh, you switch gears.

This is not as controversial as our normal tone, shall we say.

But there's no vitamin C.

There's no COVID.

We're just going to be straight to

the point. Lithium toxic ingessions or lithium toxicity. So we'll talk about the pharmacinetics,

why it's similar to sodium, how it's handled in the body, why dehydration or poor renal function

can make it worse. We'll talk about sequelae of chronic toxicity, like nephrogenic di, silent, those kind of things.

And then more importantly for those acute or acute on chronic or some chronic toxicity, we'll

talk about renal enhanced elimination, aka dialysis.

So let's get straight into it.

We do our normal resuscitation, risk assessment, etc., etc. Let's talk about specifics around

absorption, distribution, and elimination. How is this lithium 2 plus handled in the body?

So absorption of lithium depends on the formulation and the quantity. So immediate release

formulations are going to be absorbed pretty quickly within a couple hours. You know, in those

situations, there's not much we can do about it. But sustained release formulations are going to be absorbed pretty quickly within a couple hours. You know, in those situations, there's not much we can do about it.

But sustained release formulations are absorbed over four to six hours.

And especially people with large ingessions of sustained release formulations can have

increasing lithium levels for up to like 48 hours.

And they can also have pharmacopiesore.

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