Indications for Dialysis in Lithium Toxicity: A Narrative Review

Lithium is the most reliable mood stabilizer available for the treatment of bipolar disorder. However, its use is limited by multiple concerns, including acute toxicity. Lithium levels have frequently been key to decisions regarding initiation of dialysis. Following the methodological principles of the Scale for the Assessment of Narrative Review Articles (SANRA), comprehensive searches were conducted across the following databases: PubMed, Embase, Web of Science, and Cochrane Library, without limitations on publication period. In an effort to standardize and objectify the decision to use dialysis, current treatment recommendations discuss clinical presentation but ultimately rely on measured serum lithium levels. Decision making can be improved if it takes into account whether lithium toxicity occurred slowly (which is equivalent to chronic toxicity, so that clinical signs of toxicity exceed expectations of measured lithium levels) or quickly (in which measured lithium levels exceed observed clinical severity). We propose that clinicians consider these factors and suggest that involving a broader interdisciplinary team, including psychiatry, in the decision-making process could enhance outcomes.