What are early signs of lithium toxicity and when should the dose be adjusted?

• A. Hypertension and tachycardia only.
• B. Hair loss and skin rash.
• C. Weight gain and leg cramps.
• D. Coarse tremor, GI upset, confusion, ataxia.

Answer: (D)

Lithium has a very narrow safety margin, so small increases in dose or reductions in clearance can push levels into the toxic range. Early signs to recognize are neuro and GI symptoms that signal rising lithium in the body. Coarse tremor is a classic motor sign of early toxicity, and GI upset like nausea or vomiting often accompanies it. Subtle changes in mental status, such as confusion, can also appear early. Because these symptoms reflect the drug’s effect on the nervous system, they indicate it’s time to reassess the dose—reduce or temporarily hold the medication and check the serum lithium level. If symptoms or the level worsen and more severe signs develop, such as pronounced confusion or ataxia, that points to more significant toxicity and necessitates prompt medical evaluation and appropriate management. Other nonspecific signs like hair loss, skin rash, or mere weight gain aren’t characteristic early toxicity indicators.