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med's go on Instagram: "Lithium toxicity is often precipitated by drugs that reduce renal clearance of lithium, since lithium is almost entirely excreted by the kidneys. Thiazide diuretics like hydrochlorothiazide increase sodium loss, leading to compensatory proximal tubule reabsorption of sodium—and lithium follows the same pathway—causing elevated lithium levels. This can produce confusion, ataxia, slurred speech, and coarse tremor. Other listed medications do not significantly affect lithium
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Lithium has a very narrow therapeutic window, and small changes in kidney function or medications can quickly push levels into the toxic range. One of the most important clinical pearls is remembering the medications and conditions that reduce lithium clearance. A simple way to remember the major culprits is SALT. S – Sodium depletion: dehydration, vomiting, diarrhea, or low sodium intake cause the kidneys to conserve sodium. Because lithium is handled like sodium in the proximal tubule, the kid
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