Extracorporeal Treatments in Poisoning Workgroup indications for hemodialysis in lithium toxicity8
| Indication | Strength of recommendation | Serum lithium concentration | Clinical features |
|---|---|---|---|
| Hemodialysis initiation | Recommended | > 4.0 mmol/L with abnormal GFR | Decreased level of consciousness, seizures or life-threatening dysrhythmias |
| Suggested | > 5.0 mmol/L | Confusion, or lithium level not expected to fall to < 1.0 mmol/L within 36 h with optimal management | |
| Hemodialysis cessation | Recommended | < 1.0 mmol/L | Clinical improvement apparent (minimum 6 h of hemodialysis if serum lithium levels not available) |
Note: GFR = glomerular filtration rate.