Lithium as a dialyzable toxin

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Lithium is one of the classic dialyzable toxins, as it is very small (atomic # of 3) and elevated Li levels (>2.5 meq/L) may result in tremor, ataxia, vomiting, seizures, or even coma.

However it is somewhat unique amongst toxins in that chronic users tend to have a greater susceptibility to Li toxicity than an individual taking an acute Li overdose for the first time. This is based on the fact that Li has a very high volume of distribution (VOD), and it takes a large exposure (usually over a prolonged period of time) in order to saturate these stores.

Also, as a result of its large VOD, dialysis in instances of Li toxicity may require prolonged periods of time and/or multiple sequential days of dialysis due to a significant “rebound effect.”

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