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.