2. Triage

3. HPI  25 yo F with PMHx significant for migraines, IBS, bipolar disorder (on Lithium, Lexapro, Klonopin), hypothyroidism, and PCOS who presents to the ED after ingestion of >10 lithium 600 mg pills 1 hour PTA as a "suicidal gesture.” Complaining of a mild frontal headache.

4. Poison ControlPoison Control Chem 8 TSH Q2hrs Lithium level Q2hrs EKGRehydrate

5. LABS Na139 K3.7 Cl105 Bicarb26 Glucose52 BUN10 Cr0.8 TSH201.9

6. Lithium= 2.5 Normal saline bolus x3 Lithium= 3.6 Lithium= 4.1 Lithium= 0.7 Poison Control  Dialysis! Patient now with abdominal pain Quinton Dialysis x1

7. Lithium ToxicityLithium Toxicity L: Lethargy I: Insipidus (Diabetes) T: Tremors H: Hypothyroidism I: Increased Nausea, Vomiting, Diarrhea U: Urination M: Mom’s Beware (Teratogenic)

8. Lithium  DOC for Bipolar  Narrow therapeutic index  Immediate release vs Sustained release  Excreted almost entirely by the kidneys

9. Lithium

10. Treatment  Treatment:  ABCs  IVF  Kayexalate  Whole bowel irrigation

11. Hemodialysis  Lithium levels >6mEq/L: any patient  Lithium levels >4 mEq/L: any patient on chronic lithium therapy  Lithium levels between 2.5-4mEq/L: any patient with severe neurologic symptoms, renal disease, unstable hemodynamics

12. My PatientMy Patient  Admitted to MICU    Discharged to Inpatient Psychiatry  Lithium overdose  Now level 0.3  Quinton removed s/p 1 session of dialysis  Hypothyroidism  TSH >200  Started on levothyroxine 125mcg daily  Repeat TFTs in 1 week since start of LT4