Substance
Lithium

Pathology
Lithium often produces cellular disturbances in the central nervous system, kidneys, and gastrointestinal tract. This is probably due to its effects on cell membrane ion transport, as well as its effects on cAMP.

Symptoms
Nausea, vomiting, diarrhea, fine resting tremor, lethargy, confusion, tremors, ataxia, ECG abnormalities, profound weakness, muscle fasciculations, hyperreflexia, clonus, stupor, seizures, acute renal failure, coma, death.

Emergency Measures
Maintain the airway and provide assisted ventilation to patients who are comatose or difficult to arouse. For acute ingestions use gastric lavage or whole bowel irrigation. Activated charcoal is ineffective because it does not bind to metals. Hemodialysis is used to clear lithium from the body in life-threatening intoxications.

Comments
Chronic or acute-on-chronic overdoses are more life threatening than acute poisonings. Chronic exposure permits intracellular accumulation. In acute poisonings, most lithium remains in the extracellular fluid for many hours, causing toxicity.