Figure 1114

Symptoms and signs of toxic effects of lithium. Lithium can cause acute functional and histologic (usually reversible) renal injury. Within 24 hours of administration of lithium to humans or animals, sodium diuresis occurs and impairment in the renal concentrating capacity becomes apparent. The defective concentrating capacity is caused by vasopressin-resistant (exogenous and endogenous) diabetes insipidus. This is in part related to lithium's inhibition of adenylate cyclase and impairment of vasopressin-induced generation of cyclic adenosine monophosphatase.

Lithium-induced impairment of distal urinary acidification has also been defined.

Acute lithium intoxication in humans and animals can cause acute renal failure. The clinical picture features nonspecific signs of degenerative changes and necrosis of tubule cells [21]. The most distinctive and specific acute lesions lie at the level of the distal tubule [22]. They consist of swelling and vacuolization of the cytoplasm of the distal nephron cells plus periodic acid-Schiff-positive granular material in the cytoplasm (shown to be glycogen) [23]. Most patients receiving lithium have side effects, reflecting the drug's narrow therapeutic index.

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