Lithium chloride is toxic if enough of it is swallowed, and as a dust or strong solution it irritates skin, eyes and lungs. The harm comes from lithium itself, the same ion doctors prescribe for bipolar disorder, where the gap between a helpful dose and a harmful one is narrow. In the late 1940s lithium chloride was sold as a table-salt substitute for people on low-salt diets, and it poisoned some of the heart patients who used it freely, which led to its withdrawal.1JAMA. Lithium chloride as a substitute for sodium chloride in the diet; observations on its toxicity How much reaches the blood and how well the kidneys can clear it matter more than how it got into the body.
Why Lithium Chloride Harms the Body
The chloride part is not the concern. Lithium chloride, lithium carbonate (the usual prescription form) and lithium orotate (sold as a supplement) deliver lithium to the body the same way and are cleared the same way.2PubMed. Lithium orotate, carbonate and chloride: pharmacokinetics, polyuria in rats A poisoning from lithium chloride therefore looks like, and is treated like, an overdose of prescription lithium. The gut absorbs lithium easily, so almost everything swallowed reaches the blood.3PubMed Central. Lithium therapy and its interactions
Lithium is similar in size and charge to sodium, the main part of table salt, and the body treats the two alike.4BJPsych Advances. Management of lithium intoxication When you are short of salt or water, the kidneys pull back sodium, and lithium comes along with it.5BJPsych Advances. Management of lithium intoxication That means dehydration from vomiting or diarrhea can raise lithium levels without any extra being taken.6BJPsych Advances. Management of lithium intoxication The kidneys are also the main way lithium leaves the body, so anything that slows them lets it accumulate.7PubMed Central. Lithium therapy and its interactions That explains the 1940s salt substitute: people on low-salt diets were exactly those whose kidneys hold on to lithium most, and many had heart or kidney disease, which slows clearance further.
Inside cells, high lithium damages energy production. In lab experiments, it damages cells, including the parts that make energy.8Main Group Metal Chemistry. A new approach on lithium-induced neurotoxicity using rat neuronal cortical culture: Involvement of oxidative stress and lysosomal/mitochondrial toxic Cross-Talk Damage grows with the dose, which is why blood level matters so much.9Main Group Metal Chemistry. A new approach on lithium-induced neurotoxicity using rat neuronal cortical culture: Involvement of oxidative stress and lysosomal/mitochondrial toxic Cross-Talk
Signs of Lithium Poisoning and the Levels Behind Them
Doctors measure the amount of lithium in the blood in mmol/L (also written mEq/L or mM). These are the markers they use:
- Treatment range: 0.6 to 1.0 mmol/L in blood for people prescribed lithium.10PubMed. Review of lithium effects on brain and blood
- 1.5 to 2.0 mmol/L: mild, usually reversible effects on kidneys, liver, heart and glands.11PubMed. Review of lithium effects on brain and blood
- Above 2.0 mmol/L: nervous system symptoms such as poor coordination become likely.12PubMed. Review of lithium effects on brain and blood
Lithium can affect many organs, but the brain and nerves are the main target.13PubMed. Lithium Poisoning Symptoms range from none at all with a high level to confusion, clumsy unsteady walking and seizures.14PubMed. Lithium Poisoning Early signs often include nausea, vomiting, diarrhea, a coarse hand tremor and drowsiness. A blood lithium level that stays above 2 mmol/L for a long time can cause permanent brain damage.15PubMed. Review of lithium effects on brain and blood
How the poisoning starts depends on how it happens. Swallowing a large amount at once often brings vomiting and diarrhea first, with brain symptoms later. A slow build-up, such as dehydration in someone on lithium, often shows as confusion and unsteadiness. Slow build-up is often more dangerous at the same blood level because lithium has had time to reach the brain.
Heart rhythm changes can appear too. The most common heart finding is a harmless-looking change on the ECG, the heart tracing.16PubMed Central. Lithium‐induced electrocardiographic changes: A complete review Lithium can also slow the heart, block its electrical signals or cause dangerous rhythms.17PubMed Central. Lithium‐induced electrocardiographic changes: A complete review In about a quarter of poisonings, the heart’s recovery time between beats lengthens, and in over half of those it reaches a range linked to dangerous rhythms.18PubMed Central. Effects of Toxic Lithium Levels on ECG—Findings from the LiSIE Retrospective Cohort Study These problems were more common with slow build-up. In one reported case the rhythm problems came and went as the blood level rose and fell, settling once lithium cleared.19PubMed Central. Chronic lithium intoxication: Varying electrocardiogram manifestations
A person who looks fine can still need checking. Symptoms lag behind swallowing, so feeling well an hour later proves little, and only a blood test shows the level.
The blood level and the symptoms don’t always match. One person can look fairly well with a high level, and another can be clearly unwell at a lower one, so the number is a guide and not a verdict. Doctors read it together with the symptoms, how the person has been taking lithium, and how well the kidneys are working.
Touching, Breathing or Splashing Lithium Chloride
Lithium chloride enters the body when its dust or mist is breathed in or when it is swallowed.20International Chemical Safety Cards. LITHIUM CHLORIDE It barely evaporates at room temperature, so the risk comes from dust or spray, not fumes.21International Chemical Safety Cards. LITHIUM CHLORIDE Pouring, scooping, blending and cleaning up spilled powder are the moments to watch.22NICNAS IMAP Group Assessment Report. Lithium chloride: Human health tier II assessment
Breathing in the dust can irritate the airways, and people with asthma, emphysema or chronic bronchitis may be harmed more.23Santa Cruz Biotechnology. Material Safety Data Sheet: Lithium Chloride, sc-203110 Repeated or prolonged skin contact can cause redness, swelling, blisters, scaling and thickened skin.24Santa Cruz Biotechnology. Material Safety Data Sheet: Lithium Chloride, sc-203110 Eye splashes are a main concern in workplaces that handle it openly.25NICNAS IMAP Group Assessment Report. Lithium chloride: Human health tier II assessment Limited evidence suggests repeated long-term workplace exposure may have cumulative effects on organs.26Santa Cruz Biotechnology. Material Safety Data Sheet: Lithium Chloride, sc-203110
A single skin splash may sting or redden, but it is very unlikely to cause lithium poisoning, because very little lithium crosses intact skin. Irritation that builds over days suggests repeated contact and a need for better gloves.
Basic protection is simple. Wear gloves and safety glasses, and handle powder where dust won’t blow around. Wash skin with plenty of water after contact, and rinse eyes for at least 15 minutes after a splash. Don’t eat or drink where it is handled, and keep it away from children and pets.
At home, some moisture-absorbing humidity products contain lithium chloride solution. Handling a sealed pack is low risk. The danger is a child or pet chewing it or drinking spilled liquid, and any swallowed amount is a reason to call poison control.
Things That Make Lithium Build Up
The medicines most likely to interact with lithium are anti-inflammatory painkillers such as ibuprofen, blood pressure drugs called ACE inhibitors and sartans, and water pills.27PubMed Central. Lithium therapy and its interactions They change how the kidneys filter and reabsorb sodium, and lithium follows.28Medsafe. Drug Interactions with Lithium and Therapeutic Drug Monitoring Most anti-inflammatory painkillers and water pills raise lithium levels, thiazide water pills most of all.29Archives of Clinical Psychiatry (São Paulo). Lithium interactions with non-steroidal anti-inflammatory drugs and diuretics – A review
A medicine added later can cause trouble precisely because lithium may have been stable for years, so people don’t expect a new prescription or an over-the-counter painkiller to upset it. The effect builds over days to a couple of weeks after the new drug starts, so the link is easy to miss. A person who becomes shaky, nauseated or unusually sleepy soon after starting a new medicine should mention lithium and ask about a level check.
Vomiting, diarrhea, heavy sweating or not drinking enough leave the body short of salt and water.30BJPsych Advances. Management of lithium intoxication These are the times when the same intake becomes more dangerous. Existing kidney disease also slows lithium clearance.
If you take prescription lithium, ask before starting over-the-counter ibuprofen or naproxen; acetaminophen is usually the safer painkiller. Tell any new prescriber you take lithium, especially for blood pressure. During a stomach bug, call your doctor about checking your level. Keep fluids and salt intake steady rather than cutting salt suddenly. The same factors matter for one-off exposures: someone already on a water pill clears accidental lithium more slowly, and older adults and people with kidney disease are at higher risk.
What to Do After Swallowing or Heavy Exposure
If lithium chloride is swallowed, call poison control (in the US, 1-800-222-1222) or emergency services right away. Seek emergency care at once for confusion, severe unsteadiness, seizures, fainting or an irregular heartbeat. Bring the container or label so staff know the product and strength.
When you call poison control, give the product name and strength, roughly how much may have been swallowed, and when it happened. Say who it involved, including age and approximate weight, especially for a child or pet. Mention any prescription lithium, water pills, painkillers or blood pressure medicines, and any kidney problems, since these change the advice. Stay reachable by phone, as they may ask for updates or tell you to go to hospital.
Activated charcoal, which binds many poisons, does not bind lithium. Inducing vomiting at home is not advised either. Fluids and time, or dialysis, are what lower the level; in hospital, staff may use other ways to clear the gut, especially after slow-release tablets.
In the emergency department, staff ask how much was taken, when, and what other medicines you use. They draw a blood test for lithium, salts and kidney function, then repeat it hours later. IV fluids support the kidneys in milder cases, and the heart is monitored if levels are high or symptoms appear.
Lithium is readily removed by dialysis, where a machine filters the blood.31PubMed Central. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup It is recommended for severe poisoning, for levels above 4.0 mmol/L when kidneys are impaired, or for reduced consciousness, seizures or dangerous heart rhythms at any level.32PubMed Central. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup It is suggested above 5.0 mmol/L, with significant confusion, or when clearing lithium naturally would take more than 36 hours.33PubMed Central. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup Treatment continues until the person improves or the level falls below 1.0 mmol/L.34PubMed Central. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup No controlled trials have compared dialysis with other care, so these rules rest on expert judgment.35PubMed Central. Hemodialysis for lithium poisoning
Long-Term Effects on Kidneys, Thyroid and Calcium
In people taking lithium for years, long-term use roughly doubles the risk of moderate chronic kidney disease.36PubMed. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data It more than doubles the risk of an underactive thyroid,37PubMed. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data and it raises the chance of high blood calcium.38PubMed. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data The kidney effect happens because lithium builds up in kidney cells that respond to the water-saving hormone, so the kidneys lose their ability to concentrate urine.39Nature Reviews Nephrology. Lithium nephrotoxicity revisited Heavy thirst and passing large amounts of urine are common signs of this.40PubMed. Mechanisms of prolonged lithium therapy-induced nephrogenic diabetes insipidus These problems come from years of steady exposure, not from a single poisoning that has been treated.
People on lithium get regular blood tests that check lithium level, kidney function, thyroid and calcium. Tell your doctor about new constant thirst or night-time urination. Tiredness, weight gain or feeling cold can signal thyroid slowdown.
Lithium and Pregnancy
Lithium during pregnancy is linked to a higher chance of birth defects, about 4 in 100 exposed babies.41PubMed. Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes Heart defects affected about 1 in 100 exposed babies, and there was roughly 1 extra heart defect for every 71 exposed pregnancies.42PubMed. Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes Risk rose with dose and was clearest above 900 mg a day.43PubMed Central. Lithium Use in Pregnancy and the Risk of Cardiac Malformations Some experts argue that other factors common among people taking lithium, such as smoking or poor diet, make the true size of the risk uncertain.44PubMed. Epidemiology studies on effects of lithium salts in pregnancy are confounded by the inability to control for other potentially teratogenic factors
Most babies exposed to lithium in pregnancy are born without a birth defect. The increase is modest, and doctors weigh it against the dangers of untreated bipolar illness.
A pregnant person on lithium should not stop it suddenly, because relapse of bipolar illness carries its own risks. Plan with your doctor before or early in pregnancy. Doctors may adjust the dose and offer a detailed fetal heart scan.
Pregnant lab or industrial workers can ask about reassignment from open powder handling. Good gloves, eye protection and dust control keep exposure very low, and any swallowing or heavy inhalation should be reported promptly.
Disposal and Effects on Wildlife
Fingernail clams and water fleas are harmed at lithium levels of around 1 to 2 milligrams per litre of water.45Environmental Toxicology and Chemistry. Chronic toxicity of lithium to the fingernail clam Pisidium dubium and the water flea Daphnia pulex A proposed safe limit for freshwater is 0.034 milligrams per litre.46Environmental Toxicology and Chemistry. Chronic toxicity of lithium to the fingernail clam Pisidium dubium and the water flea Daphnia pulex These animals are small, filter water constantly and take up dissolved substances readily. Harm to them can disturb food webs, since larger animals depend on them, and lithium dissolves easily and doesn’t break down, so it stays in water instead of fading away.
Effects reach other life too. In plant cells, lithium at environmental levels can disrupt cell division.47PubMed Central. Lithium chloride at environmental concentrations impairs microtubule function and promotes genotoxicity in Allium cepa In farmed fish, too much lithium in feed led to fatty liver and inflammation.48PubMed. Toxicological impacts of excessive lithium on largemouth bass (Micropterus salmoides): Body weight, hepatic lipid accumulation, antioxidant defense and inflammation response
For leftover lithium chloride, follow your workplace or school chemical waste rules. At home, take it to a household hazardous waste collection. Don’t pour large amounts into drains or soil.