This condition is usually reversible when lithium is discontinued. Such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity. Lithium-Induced Renal Effects Chronic lithium therapy may be associated with diminution of renal concentrating ability, occasionally presenting as nephrogenic diabetes insipidus, with polyuria and polydipsia. If possible, lithium should be withdrawn for at least the first trimester unless it is determined that this would seriously endanger the mother. If the patient becomes pregnant while taking lithium, she should be apprised of the potential risk to the fetus. Data from lithium birth registries suggest an increase in cardiac and other anomalies, especially Ebstein’s anomaly. Studies in rats, rabbits and monkeys have shown no evidence of lithium-induced teratology. There have been reports of lithium having adverse effects on nidations in rats, embryo viability in mice, and metabolism in-vitro of rat testis and human spermatozoa have been attributed to lithium, as have teratogenicity in submammalian species and cleft palates in mice. Pregnancy Lithium may cause fetal harm when administered to a pregnant woman. Consultation with a cardiologist is recommended if: (1) treatment with lithium is under consideration for patients suspected of having Brugada Syndrome or patients who have risk factors for Brugada Syndrome, e.g., unexplained syncope, a family history of Brugada Syndrome, or a family history of sudden unexplained death before the age of 45 years, (2) patients who develop unexplained syncope or palpitations after starting lithium therapy. Lithium should generally be avoided in patients with Brugada Syndrome or those suspected of having Brugada Syndrome. Brugada Syndrome is a disorder characterized by abnormal electrocardiographic (ECG) findings and a risk of sudden death. Unmasking of Brugada Syndrome There have been postmarketing reports of a possible association between treatment with lithium and the unmasking of Brugada Syndrome. Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to therapeutic levels (see DOSAGE AND ADMINISTRATION).
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