A patient with bipolar disorder taking lithium presents with coarse tremors, ataxia, dysarthria, and confusion. Serum lithium is 4.2 mEq/L. What is the definitive treatment?

Answer and explanation

Correct answer: C. Emergency hemodialysis therapy

  1. Step 1: Severe lithium intoxication impairs renal concentrating ability and causes life-threatening cerebellar and central nervous system neurotoxicity.
  2. Step 2: Hemodialysis is the treatment of choice for severe lithium toxicity when serum levels exceed 4.0 mEq/L (or > 2.5 mEq/L with severe neurologic symptoms or renal failure), rapidly clearing the dialyzable monovalent cation.
Answer
Emergency hemodialysis therapy.
Why not the others: Activated charcoal does not bind small charged inorganic ions like lithium and has zero efficacy. Sodium polystyrene sulfonate binds potassium in the colon with minimal affinity for lithium. Flumazenil is a benzodiazepine antagonist that has no action on lithium.

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