Toxicology

Suggested indications for the use of hemodialysis include (Chest 2008;133:1006-13):

Severe toxicity (severe altered mental status or seizures)

ii.

Renal failure (cannot eliminate lithium)

iii.

Lithium concentrations greater than 2.5 mmol/L in chronic exposures

iv.

Lithium concentrations greater than 4 mmol/L in acute exposures

Monitor for cardiac toxicity with a 12-lead ECG, CK-MB, and troponins.

Monitor renal function with urine output, BUN, and SCr.

Monitor baseline lithium concentrations and then every 6 hours after until concentrations have

decreased to less than 1.5 mmol/L (normal 0.6–1.2 mmol/L).

Patient Case

the roommate is concerned because she “seems really out of it.” According to the roommate, the patient had

an appointment with the physician today, and she had been given a prescription to refill olanzapine 5 mg by

mouth daily, but the bottle is empty. On physical examination, she is alert and oriented person, place and

time but she dozes off several times. Her vital signs are stable, and a 12-lead ECG shows sinus tachycardia.

Which intervention is most appropriate for this patient?

Oral hypoglycemics accounted for 5944 single-agent exposures and 29 deaths in 2022.

sulfonylureas and the glucagon-like peptide-1 (GLP-1) receptor agonists.

The most serious adverse effects were reported with the sulfonylureas; however, most fatalities were

associated with metformin.

Clinical signs and symptoms include hypoglycemia (not with metformin), nausea, vomiting, dizziness,

tachycardia, and diaphoresis.

and metabolic (lactic) acidosis.

Stabilization of the ABC

Consider gastric decontamination with single-dose activated charcoal if patients present within 1 hour

of overdose.

2006;63:929-38).