Rosh Emergency Medicine Practice Test

A patient presenting with confusion, diarrhea, and tremor has a lithium level of 2.2 mEq/L. What is the expected clinical approach?

1. Gastrointestinal decontamination with oral activated charcoal

2. Hemodialysis

3. Intravenous hydration with isotonic saline

4. Intravenous hydration combined with hydrochlorothiazide

The correct answer is: Intravenous hydration with isotonic saline

The clinical scenario presented involves a patient with symptoms of confusion, diarrhea, and tremor, alongside a significantly elevated lithium level of 2.2 mEq/L, which indicates lithium toxicity. In managing cases of lithium toxicity, the primary goal is to reduce the lithium levels in the body and restore proper hydration and electrolyte balance. Intravenous hydration with isotonic saline is often the first step in managing lithium toxicity. This approach serves several purposes: it helps to dilute the serum lithium concentration, promotes renal excretion of lithium, and corrects any possible dehydration that may have occurred, particularly since diarrhea can contribute to volume depletion. Isotonic saline is preferred as it helps maintain sodium balance and prevents further renal impairment. In this case, while other interventions may be considered in more severe cases, such as hemodialysis for cases of life-threatening toxicity, beginning with isotonic saline infusion is the correct initial management strategy for this level of lithium. Overall, the focus on hydration in the setting of lithium toxicity is crucial as it can significantly impact the patient's clinical stability and outcomes.