What is the first line of management for acute lithium toxicity?

In cases of acute lithium toxicity, the primary objective is to quickly reduce the lithium levels in the body and prevent further absorption of the drug. The first and most appropriate line of management is to provide hydration, which helps to facilitate renal clearance of lithium. Administering intravenous fluids can increase urine output and assist the kidneys in excreting lithium, effectively lowering its concentration in the bloodstream.

This approach focuses on addressing the immediate complication of elevated lithium levels. Other options, while possibly relevant in specific circumstances or at later stages of treatment, do not serve as the initial management strategy. For instance, activated charcoal is typically utilized for certain oral overdoses but is less effective once lithium has been absorbed into the system. Pumping the stomach (gastric lavage) is rarely done and reserved for very specific situations, while dialysis is considered a more advanced intervention that usually occurs after initial steps like rehydration have failed or if the toxicity is severe. Therefore, the most suitable first action in the management of acute lithium toxicity is to ensure adequate hydration.