A 45-year-old has a large overdose of lithium. What is the best treatment method?

In the case of a large overdose of lithium, hemodialysis is considered the best treatment method due to lithium's unique pharmacokinetics. Lithium has a narrow therapeutic index, meaning that the difference between effective and toxic doses is small, and it is primarily eliminated by the kidneys. In a situation where there is a significant overdose, the kidneys may struggle to excrete the lithium efficiently, leading to potentially life-threatening levels in the bloodstream.

Hemodialysis effectively removes lithium from the blood, making it a crucial intervention in severe cases, especially when serum levels are extremely high or the patient exhibits symptoms of toxicity, such as neurological impairment or renal failure. It offers rapid clearance of lithium, which is essential for preventing further complications.

While activated charcoal and whole bowel irrigation can sometimes be used in cases of acute poisoning to reduce absorption of various substances, they are not as effective in the case of lithium overdose due to the drug's absorption characteristics and slow gastric emptying time. Gastric lavage is generally less favored in modern practice because of concerns about its safety and efficacy, particularly for substances like lithium which do not respond as well to these methods.

Thus, hemodialysis stands out as the most effective and direct method to manage a large lithium overdose