Bedside Snapshot
- Normal / Therapeutic
- None expected without lithium. Therapeutic 0.6–1.2 mEq/L (0.6–1.2 mmol/L): maintenance usually 0.6–1.0, acute mania 0.8–1.2. Older adults lower. Draw 12 h after the last dose
- Toxic Thresholds
- ≥1.5 mEq/L (1.5 mmol/L): toxic range
- >3 mEq/L: seizures, coma possible
- Dialysis: >4.0 with impaired kidneys, or >5.0
- Any level with coma, seizures or dysrhythmia
- Toxicity Looks Like
- Acute: nausea, vomiting, diarrhea first. Chronic: coarse tremor, ataxia, slurred speech, confusion, myoclonus, hyperreflexia, seizures, coma. ECG: T-wave flattening, sinus bradycardia, QTc prolongation
- Antidote / Definitive Care
- No antidote. Restore volume with 0.9% saline; hemodialysis is definitive (CRRT an acceptable alternative). Charcoal does not bind lithium. Poison center 1-800-222-1222
- Act Now If
- Reduced consciousness, seizures, dysrhythmia, or level >4.0 mEq/L with impaired kidneys: protect airway, stop lithium, saline if dry, call poison center and nephrology for dialysis
- Watch Out For
- Chronic toxicity at a modest level: confusion or ataxia at 2 mEq/L is severe poisoning, and the number alone does not show how much brain damage has occurred
Reference & Critical Ranges
Lab-specific ranges: Each lab and analyzer sets its own interval, and the population matters too. Read the range on your report first. The values below are typical.
Reference ranges
| Population | Conventional | SI | Notes |
|---|---|---|---|
| Not taking lithium | None expected | None expected | Any measurable level means exposure |
| Adult, maintenance | 0.6–1.0 mEq/L | 0.6–1.0 mmol/L | ISBD/IGSLI 2019: 0.6–0.8 standard; 0.8–1.0 if response is poor and tolerance good. FDA label maintenance goal 0.8–1.0 |
| Adult, acute mania | 0.8–1.2 mEq/L | 0.8–1.2 mmol/L | FDA label acute goal. Usual therapeutic window overall 0.6–1.2 mEq/L |
| Older adults | 0.4–0.6 mEq/L usual | 0.4–0.6 mmol/L | ISBD/IGSLI majority view: up to 0.7–0.8 at 65–79 yr, up to 0.7 at 80 yr and older. Toxicity can occur inside the adult range |
| Pregnancy | Same targets | Same targets | Clearance rises in pregnancy, so levels fall; it drops abruptly at delivery. Check levels often |
| Children | Same as adult | Same as adult | Label targets for ages 7–17 match adult targets. Not established under 7 yr |
Severity & critical values
| Level | Concentration | When to draw | Meaning |
|---|---|---|---|
| Therapeutic | 0.6–1.2 mEq/L | 12 h after the last dose (trough) | Fine tremor, thirst and polyuria are common. Sensitive and older patients can be toxic at these levels |
| Above target | >1.2 to <1.5 mEq/L | Trough; repeat if timing is uncertain | Review dose, renal function, fluids and new drugs |
| Critical | ≥1.5 mEq/L (≥1.5 mmol/L) | Any time toxicity is suspected | Toxic range per the FDA label. The critical-call cutoff is lab-specific |
| Mild toxicity | 1.5–2.5 mEq/L | Steady state (chronic) | Coarse tremor, nausea, vomiting, diarrhea, lethargy |
| Moderate toxicity | 2.5–3.5 mEq/L | Steady state (chronic) | Confusion, ataxia, slurred speech, hyperreflexia, myoclonus |
| Severe toxicity | >3.5 mEq/L | Steady state (chronic) | Label: above 3 mEq/L, seizures, coma and irreversible brain damage can follow |
| EXTRIP dialysis thresholds | >4.0 mEq/L with impaired kidney function; >5.0 mEq/L | Any time; trend after acute ingestion | Recommended (>4.0 with impaired kidneys) or suggested (>5.0). Neurologic signs or dysrhythmia qualify at any level |
Critical values: Anything at 1.5 mEq/L (1.5 mmol/L) or above is the toxic range. Your lab sets the critical-call threshold. The severity grades fit steady-state (chronic) levels. Early levels after an acute ingestion overstate brain exposure. Decreased consciousness, seizures or a life-threatening dysrhythmia mean severe poisoning at any level. Treat the grades as teaching approximations, not label or guideline cutoffs. Serious toxicity can occur well below 3.5 mEq/L.
Conversion: mEq/L = mmol/L (lithium is monovalent); mmol/L × 6.94 = mg/L
Causes of Abnormal Results
Lithium toxicity happens when intake outruns renal elimination. Most cases are chronic and unintentional. Kidney clearance falls from dehydration, illness or a new drug, and the dose stays the same.
Sources & routes of exposure
| Source | Examples | Bedside clue |
|---|---|---|
| Prescribed lithium (chronic) | Lithium carbonate immediate-release tablets and capsules, extended-release tablets; lithium citrate solution | Patient with bipolar disorder who is ill, dehydrated or on a new medicine; confusion and tremor |
| Intentional overdose | Own supply, often extended-release | Early vomiting and diarrhea; neurologic signs may appear later. Ask about co-ingestants |
| Pediatric exploratory ingestion | A family member's tablets or solution | Unwitnessed; amount uncertain. Call poison control |
| Neonatal exposure | Maternal use in late pregnancy; breast milk | Hypotonia, lethargy, poor feeding, bradycardia |
Risk factors for toxicity
| Factor | Why it matters | Practical point |
|---|---|---|
| Volume depletion (vomiting, diarrhea, fever, heat, poor intake) | The kidney handles lithium like sodium: when sodium is retained, lithium is retained | The commonest trigger. Ask about recent illness, sweating and intake |
| Acute kidney injury or CKD | Lithium is cleared only by the kidneys | Label: avoid lithium below CrCl 30 mL/min; lower doses at 30–89 |
| Nephrogenic diabetes insipidus | Lithium-induced inability to concentrate urine; any missed drinking quickly dehydrates | Polyuria plus restricted water access (sedated, intubated, NPO) is high risk |
| Interacting drugs | Diuretics, NSAIDs, ACE inhibitors, ARBs and metronidazole raise levels | Check the level after starting or changing any of them |
| Sodium change | Low-salt diet or hyponatremia increases lithium retention | Lithium itself can cause sodium loss |
| Older age, heart disease | Lower GFR and greater sensitivity | Toxicity at levels younger adults tolerate |
Classic chronic scenario: An older adult on stable lithium gets gastroenteritis or starts an NSAID, ACE inhibitor or diuretic. They dry out. Now they are confused, with coarse tremor and ataxia, and the level looks only moderately raised. Treat it as severe poisoning.
Acute vs acute-on-chronic vs chronic
| Feature | Acute | Acute-on-chronic | Chronic |
|---|---|---|---|
| Typical patient | Not taking lithium; intentional or exploratory ingestion | Taking lithium; takes an extra amount | Taking lithium; clearance falls |
| Level | Can be very high early; correlates poorly with brain exposure | High; brain stores already present | Often only moderately raised |
| Symptoms | GI first; neurotoxicity uncommon if kidneys work; may be delayed up to 24 h | GI and neurologic | Neurologic: tremor, ataxia, confusion, myoclonus, seizures |
| Risk of lasting deficit | Low with normal kidneys | Higher than acute ingestion alone | Real; older patients most at risk |
Low (subtherapeutic, <0.6 mEq/L)
Missed doses or nonadherence. A sample drawn long after the last dose reads low. Pregnancy raises clearance. Drugs that increase excretion (acetazolamide, xanthines such as theophylline, alkalinizing agents, SGLT2 inhibitors) lower it, and so do large saline loads. A low level is not an emergency. It can still signal relapse risk, so tell the prescriber.
Interpretation & Bedside Approach
Step-by-step approach
- Is it real? Confirm a serum (red or gel top) sample, never a lithium-heparin (green top) tube, which falsely raises the result. Note the last dose time: a level within 12 h of a dose reads high.
- How sick is the patient? Check mental status, gait, tremor, myoclonus and reflexes; get a 12-lead ECG, sodium, creatinine, glucose, calcium and TSH if chronic. Decreased consciousness, seizures or dysrhythmia mean severe poisoning whatever the number.
- Acute, acute-on-chronic or chronic? Ask about the usual dose, formulation (extended-release?), time and amount of any ingestion, recent illness and new drugs.
- Trend the level and the kidneys: after an acute ingestion repeat levels until they clearly fall (extended-release can peak late). Trend creatinine, urine output and sodium.
- Apply EXTRIP 2015: use the table below together with clinical status, kidney function and the toxicity pattern.
- Escalate or dispose: poison center (1-800-222-1222), nephrology early when dialysis may be needed; ICU for neurologic toxicity. Mild chronic toxicity without neurologic signs: hold lithium, restore volume and recheck.
EXTRIP dialysis criteria (2015)
| Criterion | Strength |
|---|---|
| Decreased consciousness, seizures or life-threatening dysrhythmia, at any level | Recommended (1D) |
| Level >4.0 mEq/L with impaired kidney function | Recommended (1D) |
| Level >5.0 mEq/L | Suggested (2D) |
| Significant confusion | Suggested (2D) |
| Expected time to reach <1.0 mEq/L with optimal care >36 h | Suggested (2D) |
Impaired kidney function is often read as eGFR <45 mL/min/1.73 m². A 2020 Australian validation tested them. These criteria would have dialyzed 58% of chronic and acute-on-chronic patients. Asking for a concentration criterion and a clinical criterion together pointed dialysis at the patients who later had neurologic sequelae. The call belongs to local toxicology and nephrology.
ECG patterns
| Pattern | Suggests |
|---|---|
| T-wave flattening or inversion | Common and reversible; also seen at therapeutic levels |
| Sinus bradycardia, sinoatrial block, sinus node dysfunction | The typical conduction effect of lithium; can be severe in toxicity |
| QTc prolongation, ventricular tachyarrhythmia | Toxicity; correct K⁺ and Mg²⁺ and monitor continuously |
| Brugada pattern | Label warning: lithium can unmask Brugada syndrome. Cardiology for syncope or palpitations on lithium |
Treat the patient, not the number: In chronic toxicity, severe brain toxicity occurs at moderate levels. The serum number does not reliably predict permanent deficits. After acute ingestion, a high early level with a normal exam is common. The neuro exam, the kidneys and the trend decide it.
Management Priorities
Emergency: Severe lithium toxicity (neurologic signs, dysrhythmia, or level at EXTRIP thresholds)
- Airway and seizures: reduced consciousness means protect the airway. Seizures get a benzodiazepine. Continuous ECG.
- Stop and restore: stop lithium and nephrotoxic or interacting drugs (NSAIDs, ACE inhibitors, ARBs, diuretics). Correct volume depletion with 0.9% saline to euvolemia. Check Na⁺ every few hours. Nephrogenic diabetes insipidus patients turn hypernatremic on saline.
- Remove: call nephrology early. Intermittent hemodialysis is the preferred method. CRRT is an acceptable alternative. Continue until the patient improves clinically or the level is <1.0 mEq/L. If levels will not come back quickly, keep going for at least 6 h.
- Monitor & repeat: keep trending, and recheck the level about 6 h after each dialysis session. Lithium rebounds from tissue stores. Serial neuro checks, urine output, creatinine and Na⁺.
Emergency: Large acute ingestion (especially extended-release)
- Do not rely on charcoal: it misses lithium. Give it only for a co-ingestant that it binds.
- Consider whole bowel irrigation: substantial ingestions only, and only after poison center or toxicologist advice. The airway must be protected and hemodynamics stable, with no ileus or obstruction.
- Trend: repeat levels every 4–6 h (or as the toxicologist directs) until they clearly fall. Extended-release products can peak late, and neurologic signs can lag by up to 24 h.
- Call: Phone the poison center at 1-800-222-1222 for every intentional or pediatric ingestion.
Medications
| Drug | Adult dose | Pediatric dose (max) | Onset / key notes |
|---|---|---|---|
| 0.9% sodium chloride: volume depletion | 500 mL IV bolus, reassess after each; repeat to euvolemia (smaller boluses in heart failure or older adults); no fixed max | 20 mL/kg IV/IO bolus (max 20 mL/kg per bolus); reassess; medical direction after 60 mL/kg | Restores GFR and lithium clearance. Watch Na⁺ for hypernatremia and lungs for overload. Do not use diuretics to push lithium out |
| Lorazepam: seizures, IV access | 4 mg slow IV (0.1 mg/kg, max 4 mg), no faster than 2 mg/min; repeat once (max 8 mg) | 0.1 mg/kg slow IV (max 4 mg/dose); repeat once | Seizures mean severe toxicity: start dialysis planning. High-alert |
| Midazolam: seizures, no IV | 10 mg IM (over 40 kg), single dose | 0.2 mg/kg IM (max 10 mg) | Then a second-line drug if still seizing. High-alert |
| Polyethylene glycol electrolyte solution (whole bowel irrigation) | 1,500–2,000 mL/hr by nasogastric tube until rectal effluent is clear | 9 months–6 yr: 500 mL/hr; 6–12 yr: 1,000 mL/hr, by nasogastric tube | Toxicologist-directed. Contraindicated with ileus, obstruction, instability or an unprotected airway |
High-alert drugs: Double-check every IV benzodiazepine independently, both dose and concentration. Bring waveform capnography or SpO₂ monitoring and airway equipment to the bedside. Total up the home, EMS and ED doses before you give another.
Definitive care & disposition
- No antidote: care is supportive, plus enhanced elimination. Lithium is small, unbound and water-soluble, so dialysis pulls it out readily.
- Dialysis decision: Weigh the EXTRIP 2015 criteria (Interpretation section) against kidney function, toxicity pattern and clinical course. A level expected to stay above 1.0 mEq/L for more than 36 h? That favors dialysis.
- ICU: any neurologic toxicity, dysrhythmia, dialysis, or hypernatremia from diabetes insipidus.
- Discharge from the toxicology standpoint: no neurologic signs and a falling level, after psychiatric assessment for intentional overdose.
- Restarting lithium: wait for recovery, then restart at a reassessed dose. Tissue stores keep releasing lithium while the patient recovers.
- Follow-up: neurologic review after severe or acute-on-chronic poisoning; deficits can persist (SILENT).
Doses are typical references. Follow local protocols, medical direction and institutional policy.
Field & Transport Considerations
Point-of-care testing
You will not run a lithium level in the field. Your tools there are the neuro exam (mental status, tremor, gait, myoclonus), the cardiac monitor and 12-lead, and glucose. On critical-care transport, a cartridge chemistry analyzer can trend Na⁺, and creatinine where available.
Before and during interfacility transport
| Setting | Consideration |
|---|---|
| EMS scene | Bring every pill bottle. Record the formulation (extended-release?), usual dose, last dose time and any ingestion time and amount. Ask about vomiting, diarrhea and new NSAIDs or diuretics |
| Sending facility | Send each level with its draw time and the last-dose time, creatinine, Na⁺, ECG and fluids given. Note whether dialysis has been arranged at the receiving center |
| En route | Continuous ECG; neuro checks; seizure precautions; track urine output (polyuria suggests diabetes insipidus). Lithium may prolong neuromuscular blockade: anticipate longer paralysis after RSI |
| Destination | A patient meeting dialysis criteria needs a center that can start hemodialysis or CRRT promptly |
Timing & Kinetics
| Parameter | Value | Clinical implication |
|---|---|---|
| Peak level (therapeutic dose) | Immediate-release 0.25–3 h; extended-release 2–6 h | A level near the peak overstates exposure |
| When to draw (monitoring) | 12 h after the last dose, just before the next | First level after 3 days of a new dose (label); recheck after any dose, drug or illness change |
| Brain distribution | Up to 24 h | Neurologic toxicity can lag behind the serum peak after an acute ingestion |
| Half-life | About 18–36 h; longer in older adults and kidney impairment | Chronic toxicity resolves slowly without dialysis |
| Repeat after acute ingestion | Every 4–6 h until clearly falling | Extended-release overdose can show late or rising peaks |
| After dialysis | Recheck about 6 h after each session | Rebound from tissue stores may need another session |
Write down the times: No draw time, no meaning. Put the draw time and the last-dose (or ingestion) time beside every lithium result. Without both, you cannot interpret the level or trend it.
Special Populations
| Population | What changes | Clinical implication |
|---|---|---|
| Neonates & infants | Late-pregnancy exposure can cause neonatal toxicity (hypotonia, poor feeding, cyanosis, bradycardia); breast milk transfers lithium | Supportive care; signs may last up to 14 days. Breastfeeding is not recommended on lithium (label) |
| Children & adolescents | Approved from age 7 with adult target levels; lower starting dose at 20–30 kg; not studied under 20 kg | Any exploratory ingestion: poison center. Same severity thresholds |
| Pregnancy | Clearance rises, so levels fall; clearance drops abruptly at delivery. First-trimester use carries a small rise in cardiac malformations, including Ebstein anomaly | Frequent levels; label: reduce or stop 2–3 days before delivery, restart with close monitoring. Fetal echocardiography at 16–20 weeks after first-trimester exposure. Check pregnancy status in toxicity |
| Older adults | Lower GFR, more interacting drugs, greater sensitivity | Lower targets (0.4–0.6 mEq/L usual); toxicity at levels younger adults tolerate |
| CKD / dialysis | Clearance falls with GFR | Label: avoid at CrCl <30 mL/min; start low and monitor closely at 30–89 mL/min |
| Liver disease | No hepatic metabolism | No clinically meaningful change from the liver itself; watch volume status and diuretics |
Interfering Factors & Pitfalls
Collection & handling
| Factor | Effect | Why | Avoid / fix |
|---|---|---|---|
| Lithium-heparin (green-top) tube | False + / ↑ | The tube anticoagulant contains lithium | Serum in a red-top or gel-barrier tube; labs reject lithium-heparin samples |
| Hemolysis | Unreliable | Rejected by reference labs | Redraw |
| Drawn under 12 h after a dose | ↑ | Absorption and distribution phase | Record the dose time; trough at 12 h for monitoring |
Medications & supplements
| Factor | Effect | Why | Avoid / fix |
|---|---|---|---|
| Diuretics, NSAIDs, ACE inhibitors, ARBs, metronidazole | ↑ (true) | Less renal lithium clearance | Recheck the level after starting or changing; reduce the dose |
| Acetazolamide, theophylline and other xanthines, alkalinizing agents, SGLT2 inhibitors | ↓ (true) | More urinary lithium excretion | Recheck the level after starting or changing |
Assay & device-specific
| Factor | Effect | Why | Avoid / fix |
|---|---|---|---|
| Units | None | mEq/L and mmol/L are numerically equal for lithium | Confirm units only if mg/L is reported (÷ 6.94) |
| Serum vs red-cell lithium | Different values | Red-cell lithium is a research or specialty test | Use serum levels for toxicity decisions |
Common misinterpretations
- “Only 2.0, so mild”: Confusion or ataxia at a moderate level? That is severe poisoning in chronic toxicity.
- “Very high, but the patient looks fine, so the lab is wrong”: early after an acute ingestion, the brain has not caught up. Repeat the level and watch for 24 h.
- “The level fell after dialysis, so it is over”: Rebound happens. Recheck before you call it done.
- “Normal level, so not lithium”: Sensitive and older patients can be toxic inside the therapeutic range. Lithium with an antipsychotic or a serotonergic drug can cause neurotoxic syndromes.
Green-top tubes: A lithium-heparin tube can make a level read falsely toxic. Before you start dialysis on a value that does not fit a well patient, confirm the tube type and repeat on serum.
Physiology & Test Basics
What it measures
This is the concentration of lithium ion (Li⁺) in serum. Lithium is used for bipolar disorder, and its therapeutic index is narrow. Toxic levels start at 1.5 mEq/L, close to the top of the therapeutic range. The serum level lags, and it is not the brain level, where toxicity occurs.
Physiology & regulation
- Absorption: complete from the upper GI tract. Extended-release products absorb slowly.
- Distribution: total body water (0.7–1 L/kg). Protein binding is negligible. Entry into the brain is slow, up to 24 h.
- Elimination: It is not metabolized. The kidneys excrete it. About 80% of filtered lithium is reabsorbed in the proximal tubule, alongside sodium.
- Sodium link: Sodium depletion, dehydration and diuretics all push lithium reabsorption up. The level rises with them.
- Kidney effects: Lithium blunts the collecting-duct response to vasopressin (nephrogenic diabetes insipidus). It can also cause chronic tubulointerstitial nephropathy and renal tubular acidosis.
- Other effects: hypothyroidism, hyperparathyroidism with hypercalcemia, hyponatremia.
How it is measured
- Specimen: serum, red-top or gel-barrier tube. Never a lithium-heparin (green-top) tube.
- Timing: a trough, 12 h after the last dose. Record both times. In suspected toxicity, draw on arrival, whatever the timing.
- Method: automated chemistry analyzer, commonly with an ion-selective electrode. Reported in mEq/L or mmol/L, which are equal.
- Turnaround: reference labs take 1–2 days to report. Ask your hospital lab what its stat time is.
Why it matters
Lithium toxicity is common and often iatrogenic. It can leave permanent cerebellar and cognitive deficits. Read with the neuro exam, creatinine and sodium, a correctly timed level decides between holding a dose, fluids and observation, or emergency dialysis.
Clinical Pearls
Ask about polyuria: Lithium-induced nephrogenic diabetes insipidus means the patient must drink just to keep up. Take away the water with sedation, intubation, NPO orders or no water access, and they dehydrate fast. Lithium rises, and sodium climbs with it into hypernatremia.
Charcoal does not bind lithium: Lithium is a small cation, and charcoal won't hold it. Reserve whole bowel irrigation for substantial ingestions, after toxicology advice, with a protected airway.
Lithium plus an antipsychotic or serotonergic drug: The label warns of an encephalopathic syndrome that looks like neuroleptic malignant syndrome, and of serotonin syndrome. Fever, rigidity and confusion on lithium? Work it up fully.
SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity): Cerebellar, cognitive or extrapyramidal deficits that persist after the lithium is cleared. Lasting deficits get reported most often after chronic or acute-on-chronic toxicity. The serum level alone does not tell you who will be affected.
Transport and RSI: Lithium may prolong neuromuscular blockade, so plan for longer paralysis. Keep sedation going. Hand over the last level with its draw time.
Nursing: during saline and after dialysis: On saline, check Na⁺ and urine output every few hours. Diabetes insipidus raises the risk of hypernatremia. Check neuro status hourly. Draw the post-dialysis level about 6 h after the run ends.
Check the drug list: A new NSAID, ACE inhibitor, ARB, thiazide or metronidazole is a common trigger. So is an over-the-counter NSAID, the one patients forget to mention unless asked.
References
- Hikma Pharmaceuticals USA Inc. (2026). Lithium carbonate tablets and capsules, for oral use [prescribing information] (DailyMed SPL version 3, published September 2026; label text revised November 2025). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b839ff4b-f62d-41ab-a823-550a756d58ec
- Decker, B. S., Goldfarb, D. S., Dargan, P. I., Friesen, M., Gosselin, S., Hoffman, R. S., Lavergne, V., Nolin, T. D., & Ghannoum, M. (2015). Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP Workgroup. Clinical Journal of the American Society of Nephrology, 10(5), 875–887. https://doi.org/10.2215/CJN.10021014
- Buckley, N. A., Cheng, S., Isoardi, K., Chiew, A. L., Siu, W., Vecellio, E., & Chan, B. S. (2020). Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines. British Journal of Clinical Pharmacology, 86(5), 999–1006. https://doi.org/10.1111/bcp.14212
- Spatola, L., Maringhini, S., Canale, C., Granata, A., & D'Amico, M. (2023). Lithium poisoning and renal replacement therapy: Pathophysiology and current clinical recommendations. International Urology and Nephrology, 55(10), 2501–2505. https://doi.org/10.1007/s11255-023-03558-5
- Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., et al. (2019). What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar Disorders, 21(5), 394–409. https://doi.org/10.1111/bdi.12805
- Thanacoody, R., Caravati, E. M., Troutman, B., Höjer, J., Benson, B., Hoppu, K., Erdman, A., Bedry, R., & Mégarbane, B. (2015). Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clinical Toxicology, 53(1), 5–12. https://doi.org/10.3109/15563650.2014.989326
- Labcorp. (2026). Lithium (test 007708): specimen requirements, therapeutic range and causes for rejection. Labcorp test menu. https://www.labcorp.com/tests/007708/lithium
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