How does hyponatremia cause lithium toxicity?

Asked By: Oddvar Montanari | Last Updated: 26th April, 2020
Category: medical health hormonal disorders
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Hyponatremia. Lithium can cause hyponatremia by decreasing sodium reabsorption by the renal tubules, leading to sodium depletion. For more severe hyponatremia (serum Na < 115 mEq/L), stupor, neuromuscular hyperexcitability, hyperreflexia, seizures, coma, and death can result.

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Also, how does sodium affect lithium levels?

Salt consumption can cause fluctuations in serum lithium levels. A sudden decrease in sodium intake (a component of salt) may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall. Caffeine might interact with serum lithium levels.

Also Know, what are the 3 main symptoms of lithium toxicity?

  • diarrhea.
  • vomiting.
  • stomach pains.
  • fatigue.
  • tremors.
  • uncontrollable movements.
  • muscle weakness.
  • drowsiness.

Likewise, can lithium toxicity cause diabetes insipidus?

Nephrogenic diabetes insipidus (NDI) is the most common renal side effect of lithium therapy [2,3]. (See "Lithium poisoning".) NEPHROGENIC DIABETES INSIPIDUS. Normally, water permeability of principal cells in the collecting tubule is regulated by antidiuretic hormone (ADH).

How does dehydration cause lithium toxicity?

Toxicity can also be caused by taking a slightly higher dose of lithium over time. It can also occur if you are dehydrated, or you take medicines that cause lithium to build up in your blood. A decreased intake of sodium (salt) can also lead to lithium toxicity.

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How often should lithium levels be checked?

Once levels of lithium in the blood are steady, they will be checked regularly (typically 3 monthly), usually 12 hours after the last dose. You will also have blood tests at least every 6 months to check on kidney and thyroid function.

Can you drink caffeine with lithium?

Notes for Consumers: Caffeine may decrease the effectiveness of Lithium. It is advisable to limit your caffeine intake (including teas, coffees, colas and non-prescription or herbal medicines containing caffeine) while taking Lithium. Report any changes in mood or emotions to your health care provider.

What should you avoid when taking lithium?

Avoid excessive intake of caffeinated beverages, such as coffee, tea, cola or energy drinks, since these may decrease levels of lithium and decrease effectiveness of the medication. Discontinuing caffeine use may increase lithium levels.

What are the long term effects of lithium on the body?

Over the long term, lithium can cause the thyroid gland to grow (goiter) or, less often, to become underactive (hypothyroidism), which is more likely to occur in women over age 45. It can also adversely affect kidney and cardiovascular function.

What happens with too much lithium?


Too much lithium may lead to unwanted effects such as nausea, diarrhea, shaking of the hands, dizziness, twitching, seizures, slurred speech, confusion, or increase in the amount of urine. There is only a small difference between the correct amount of lithium and too much lithium.

How does lithium affect the brain?

Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior.

What food is high in lithium?

Lithium is a highly reactive, light metal naturally found in very low levels throughout the body. It is available as a dietary supplement and is commonly found in drinking water and in many foods, including grains, vegetables, mustard, kelp, pistachios, dairy, fish, and meat.

What happens when lithium levels are too low?

If the lithium level is low and below the therapeutic range you are unlikely to have side effects but you are also unlikely to benefit from the treatment. Slurred speech, unsteady gait, vomiting, diarrhoea and confusion will occur as the blood lithium concentration increases.

What medications can replace lithium?

Aripiprazole (Abilify), lamotrigine (Lamictal), lithium, olanzapine (Zyprexa), risperidone (Risperdal) Consta, and quetiapine (Seroquel) or ziprasidone (Geodon), (either one in combination with lithium or valproate) are the only drugs that have been approved by the FDA specifically for maintenance therapy for bipolar

How can you tell the difference between nephrogenic and diabetes insipidus?


There are four types of DI, each with a different set of causes. Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone). This can be due to injury to the hypothalamus or pituitary gland or genetics. Nephrogenic DI (NDI) occurs when the kidneys do not respond properly to vasopressin.

How is lithium induced diabetes insipidus treated?

For those patients unresponsive to traditional treatment measures, several pharmacotherapeutic regimens have been documented as being effective for the management of lithium-induced diabetes insipidus including hydrochlorothiazide, amiloride, indomethacin, desmopressin and correction of serum lithium levels.

What is nephrogenic diabetes insipidus?

In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body. Symptoms include excessive thirst and excretion of large amounts of urine.

Is nephrogenic diabetes insipidus reversible?

BACKGROUND: In nephrogenic diabetes insipidus (NDI), the kidney is unable to produce concentrated urine because of the insensitivity of the distal nephron to antidiuretic hormone (arginine vasopressin). The risk for conversion of reversible to irreversible NDI seems to be a potential complication.

Why is amiloride used for diabetes insipidus?

Amiloride blocks lithium entry through the sodium channel thereby attenuating the resultant nephrogenic diabetes insipidus. Amiloride reduced transcellular lithium transport, intracellular lithium concentration, and lithium-induced inactivation of glycogen synthase kinase 3beta.

What causes diabetes insipidus?


Diabetes insipidus is caused by problems with a chemical called vasopressin (AVP), which is also known as antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland until needed.

What organs are affected by lithium?

Organs most affected (and which should be monitored) include the: Kidneys: Most of the time kidney dysfunction is mild, though sometimes this can be progressive. Thyroid: Lithium can affect thyroid function in many ways. It can cause hypothyroidism, a goiter, or autoimmune thyroiditis.

Can lithium cause permanent damage?

Serum lithium levels of 1.5-2.0 mM may have mild and reversible toxic effects on kidney, liver, heart, and glands. Prolonged lithium intoxication >2 mM can cause permanent brain damage. Lithium has low mutagenic and carcinogenic risk. Lithium is still the most effective therapy for depression.