What is the initial treatment for acute lithium toxicity?

The initial treatment for acute lithium toxicity focuses on the immediate stabilization of the patient and addressing hydration status. Administering normal saline is crucial because it helps to restore intravascular volume and promote renal excretion of lithium. Adequate hydration is essential in the management of lithium toxicity, as it can help reduce serum lithium levels by enhancing renal clearance of the drug.

In cases of acute poisoning, especially with substances like lithium, hydration can alleviate some of the toxic effects while allowing the body to naturally excrete the excess lithium over time. This is particularly important because lithium has a narrow therapeutic window, and elevated levels can lead to serious complications, including neurological effects and renal impairment.

While activated charcoal can be considered in cases of recent ingestion to limit further absorption of the drug, its role is more specific to certain poisonings, and it is not the first-line treatment in lithium toxicity unless the ingestion occurred very shortly before presentation. Hemodialysis is indeed a definitive treatment for severe lithium toxicity but is typically reserved for cases where there is significant toxicity or renal failure and not for initial management. Calcium gluconate is used to treat calcium channel blocker or magnesium toxicity and does not apply to lithium poisoning, making it irrelevant in this context.