Nomogram of Buckley et al for Evaluating a Patient with Chronic Lithium Toxicity

Patient selection: chronic chronic lithium toxicity

Parameters:

(1) eGFR in mL per min per 1.73 sq meter

(2) current serum lithium concentration in mmol/L if lithium discontinued

lithium clearance *Mitoki et al) in mL/min =

= (0.161 * (creatinine clearance)) + 6.47

The nomogram projects what serum lithium level now will exceed 1 mmol/L at 36 hours from now.

X = serum lithium in mmol/L for this eGFR =

= (0.0000398 * ((eGFR)^2)) + (0.007629 * (score)) + 1.256

If the current lithium value is > X, then the serum lithium level in 36 hours will be over 1 mmol/L. More aggressive management may be appropriate.

If the current lithium value is <= X, then the serum level in 36 hours will be less than 1 mmol/L.