Asia Pacific Journal of Medical Toxicology

Clinicoepidemiological Pattern of Lithium Poisoning: Comparison of Two Decades in Tehran, Iran

Document Type : Original Article

Authors

Sara Zarei 1
Maral Ramezani 2, 3
Saeed Akbarzadeh Kolahi 4
Shahin Shadnia 5
Babak Mostafazadeh 5
Peyman Erfan Talab Evini 5
Mitra Rahimi 5

1 Tehran Medical Sciences Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University, Tehran, Iran

2 Department of Pharmacology, School of Medicine, Arak University of Medical Sciences, Arak, Iran

3 Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran

4 Department of Pharmacology and Toxicology, Tehran Medical Sciences Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University, Tehran, Iran

5 Toxicological Research Center, Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran

https://doi.org/10.22038/apjmt.2025.89318.1519
Abstract
Background: Lithium has been identified as a substance of significant toxicological concern, with the potential to inflict permanent damage to the central nervous system (CNS). This study examined cases of lithium poisoning over a period of ten years and compared them with cases from the previous decade. 
Methods: This cross-sectional and retrospective study was conducted on patients with lithium poisoning. The study population comprised 491 patients. Information regarding the patients was retrieved from the hospital archives using a checklist. Subsequent to discharge, patients were monitored for post-operative outcomes. Subsequent to the completion of the study, a comparison was made between the results obtained and those from the previous decade.
Results: Among the 491 patients (mean age 33.6±15.1 years, 65% female) included in the study, 75.6% exhibited reduced systolic blood pressure. Lithium levels exhibited a substantial decrease following dialysis (p=0.016). The mortality rate was documented to be 1.6%. During subsequent follow-up, 0.4% of the subjects resumed lithium treatment, 1.8% attempted suicide, and 15.2% consulted a psychiatrist. It is noteworthy that cases of poisoning have increased fourfold over the past decade (P<0.001). Patients who consumed 
more than 40 grams of the drug demonstrated a substantial decrease in the primary outcome (P=0.021). The proportion of hospitalizations lasting over two days decreased from 50% to 20.4% (P<0.0001).
Conclusion: The identification of lithium toxicity cases is facilitated by epidemiological data, thereby enabling a targeted management approach. A multifaceted approach is imperative to minimize toxicity risks. This approach should include the implementation of restricted re-prescription for suicidal use, stringent pharmacy controls, comprehensive family education on interactions, and regular renal monitoring.

Keywords

Toxicity
Lithium
Epidemiological Study
Poisoning
Decade
Subjects
  1. Spatola L, Maringhini S, Canale C, Granata A, D’Amico M. Lithium poisoning and renal replacement therapy: pathophysiology and current clinical recommendations. Int Urol Nephrol. 2023;55(10):2501-5.
  2. Lee Y-C, Lin J-L, Lee S-Y, Hsu C-W, Weng C-H, Chen Y-H, et al. Outcome of patients with lithium poisoning at a far-east poison center. Hum Exp Toxicol. 2011;30(7):528-34.
  3. Hanak AS, Malissin I, Poupon J, Risède P, Chevillard L, Mégarbane B. Electroencephalographic patterns of lithium poisoning: a study of the effect/concentration relationships in the rat. Bipolar Disord. 2017;19(2):135-45.
  4. Hanak A-S, Chevillard L, Lebeau R, Risède P, Laplanche J-L, Benturquia N, et al. Neurobehavioral effects of lithium in the rat: Investigation of the effect/concentration relationships and the contribution of the poisoning pattern. Prog Neuropsychopharmacol Biol Psychiatry. 2017;76:124-33.
  5. Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord. 2016;4:1-10.
  6. Ott M, Stegmayr B, Salander Renberg E, Werneke U. Lithium intoxication: incidence, clinical course and renal function–a population-based retrospective cohort study. J Psychopharmacol. 2016;30(10):1008-19.
  7. Villeneuve E, Wang JJ, Grunbaum AM, Gosselin S. Letter in response to “Lithium poisoning in the intensive care unit: predictive factors of severity and indications for extracorporeal toxin removal to improve outcome”. Clin Toxicol. 2017;55(1):67-8.
  8. Baird-Gunning J, Lea-Henry T, Hoegberg LC, Gosselin S, Roberts DM. Lithium poisoning. J Intensive Care Med 2017;32(4):249-63.
  9. Mostafazadeh B, Ghotb S, Najari F, Farzaneh E. Acute lithium intoxication and factors contributing to its morbidity: a 10-year review. Int J Med Toxicol Forensic Med. 2016;6:1-6.
  10. Murphy N, Redahan L, Lally J. Management of lithium intoxication. BJPsych Advances. 2023;29(2):82-91.
  11. Ferensztajn-Rochowiak E, Rybakowski JK. Long-term lithium therapy: side effects and interactions. Pharmaceuticals. 2023;16(1):74.
  12. Finley PR. Drug interactions with lithium: an update. Clin Pharmacokinet. 2016;55(8):925-41.
  13. Aggarwal J, Mehdi Z, Kaur B, Singh Cheema Y, Gupta M. When numbers can be misleading: lithium induced irreversible neurotoxicity at therapeutic drug levels. Journal of Emergency Practice and Trauma. 2022;8(1):69-73.
  14. Heald AH, Holland D, Stedman M, Davies M, Duff CJ, Parfitt C, et al. Can we check serum lithium levels less often without compromising patient safety? BJPsych Open. 2022;8(1):e18.
  15. Chan B, Cheng S, Isoardi K, Chiew A, Siu W, Shulruf B, et al. Effect of age on the severity of chronic lithium poisoning. Clin Toxicol. 2020;58(11):1023-7.
  16. Rahmani AH, Mohtadi S, Yazdani S. An Investigation into the Frequency and Clinical Symptoms of Lithium Poisoning in patients Admitted to Razi Hospital, Ahvaz in 2015-2018. Asia Pac J Med Toxicol. 2021;10(4):124-7.
  17. Ganter NM, Tong K, McDonald C, Doherty AM. The clinical characteristics and correlates of lithium toxicity in a tertiary referral centre. Ir J Med Sci (1971-). 2019;188:1103-9.
  18. Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry. 2001;35(6):833-40.
Asia Pacific Journal of Medical Toxicology
Volume 14, Issue 3
Summer 2025
Pages 79-85

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