Lithium toxicity can occur with normal serum lithium levels. Thiazides and ibuprofen can cause significant rise in serum lithium. Lithium as lithium carbonate is used as a psychoactive agent in the treatment of manic depressive disorders. Lithium therapy demands daily monitoring of serum lithium levels until the proper dose schedule is determined. Lithium levels peak after oral ingestion in 1-3 hours and absorption is complete in about 8 hours.
Intoxication never occurs suddenly.
Several days to a week before full-blown symptoms develop, a patient will experience lethargy, drowsiness, tremor, muscle twitching, dysarthria, anorexia and vomiting, or diarrhea. A fully developed case of intoxication shows coma to semicoma, rigidity, hyperactive reflexes, and seizures at times. There is a high incidence of pulmonary complications. It is advisable to perform periodic plasma sodium determinations. Lithium significantly inhibits antidiuretic hormone induced water transport in kidney.