1. 1978 Jul 19;58(3):317-22. Psychopharmacology (Berl) – PMID: 98804
  2. 1982 77(4):348-55. Psychopharmacology (Berl)
  3. 1976; 11(2):84-92. Int Pharmacopsychiatry
  4. 1987; Nov-Dec; 50(6): 85-7. Farmakol Toksikol
  5. Lithium – Toxicity – https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@rn+7439-93-2
6.[Rumack BH POISINDEX(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017. Hall AH & Rumack BH (Eds): TOMES(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017.] **PEER REVIEWED**

[Rumack BH POISINDEX(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017. Hall AH & Rumack BH (Eds): TOMES(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017.] **PEER REVIEWED**

Lithium effects on rat brain glucose metabolism in long-term lithium-treated rats studied in vivo.

  1. The time course of lithium effects on several brain energy metabolites has been investigated in rats. The rats were injected once daily with lithium chloride and killed by freezing in liquid nitrogen 1–8 h after the last injection. The effect of lithium was most marked in the period in which the brain lithium concentration was increasing, whereas the effect was wearing off when the brain lithium concentration had stabilized, even though the lithium concentration was higher. These results led to the hypothesis that the effect of lithium on several parameters depends on the increase in lithium concentration following the administration of lithium, rather than on the absolute concentration of lithium.

2. The effects of lithium on several brain energy metabolites were investigated in rats. Lithium was administered by three alternative routes: 1) in food, 2) via IP injection, or 3) intracisternally via the suboccipital route. Lithium given in food induced permanent changes, mainly in glycolytic processes and in glycogen content. Lithium injected IP induced, in addition, several changes which depended on the increase in brain lithium concentration following injection of lithium. These changes in brain metabolites disappeared as brain lithium concentration stabilized. Intracisternal injection of lithium produced brain lithium concentrations between 1 and 2 mmoles/kg wet wt., with a mean of about 1.6 mmoles/kg wet wt. Lithium concentrations below about 1.6 mmoles/kg wet wt. induced changes in brain metabolites which were similar to the changes seen after IP injection of lithium. Lithium concentrations above about 1.6 mmoles/kg wet wt. induced changes in several brain metabolites which were at variance with the changes induced by lower lithium concentrations. These changes were in many respects similar to changes in brain metabolites seen in rats exposed to convulsive treatment. It is hypothesized that such metabolic changes during lithium treatment, in discrete areas of the brain with higher concentration of lithium, e.g., hypothalamus, might be related to the prophylactic effect of lithium treatment in man.

3. Administration of LiCl to rats was found to affect brain glucose metabolism in the following ways. The concentrations of brain glucose, brain lactate and brain glycogen were increased, and the concentration of brain glutamate was decreased. The incorporation of (14)C from U-(14)C D-glucose, administered intraperitoneally to the rats, was increased in brain glucose and brain lactate, and decreased in brain glutamate. The results were explained by a lithium-induced increase in brain glucose uptake and an increased rate of glycolysis, and a slight inhibition of the oxidative decarboxylation of the Krebs cycle.

4. Selective activation of phosphofructokinase (PFK) and lactate dehydrogenase (LDG) in the cerebral cortex and an increase of glucose and lactate contents in all other brain areas were noted in acute alcoholic intoxication of rats (2.5 g/kg). Lithium carbonate potentiated the inhibitory action of alcohol on glycolysis in the brain tissue. In combination with ethanol it decreased the activity of PFK and LDG in all studied brain areas and increased glucose and lactate levels.

5. Toxicity Summary:

    IDENTIFICATION AND USE: Elemental lithium is a silver white metal; body centered cubic structure it becomes yellowish on exposure to moist air and it reacts with water. It is soluble in liquid ammonia forming a blue solution. It is used in the manufacture of catalysts for polyolefin plastics; in fuels for aircraft and missiles.It is used in metallurgy, as a degasifier, deoxidizer, desulfurizer; as a grain refiner in non-ferrous metals. Chemical intermediate for butyllithium polymerization catalyst; in alloys with aluminum or magnesium for aerospace uses. It is used in the production of tritium, reducing and hydrogenating agents, alloy hardeners, pharmaceuticals and Grignard reagents. Scavenger and degassifier for stainless and mild steels in molten state, modular iron, soaps and greases, deoxidizer in copper and copper alloys, heat-transfer liquid, storage batteries (with sulfur, selenium, tellurium, and chlorine). Rocket propellants, vitamin A synthesis, silver solders, underwater bouyancy devices, nuclear reactor coolent. HUMAN EXPOSURE AND TOXICITY: Elemental lithium causes severe eye and skin burns. Industrial exposures to lithium may occur during extraction of lithium from its ores, preparation of various lithium compounds, welding, brazing, enameling, and from the use of lithium hydrides. 

Animal Toxicity Studies:
Toxicity Summary:

    IDENTIFICATION AND USE: Elemental lithium is a silver white metal; body centered cubic structure it becomes yellowish on exposure to moist air and it reacts with water. It is soluble in liquid ammonia forming a blue solution. It is used in the manufacture of catalysts for polyolefin plastics; in fuels for aircraft and missiles.It is used in metallurgy, as a degasifier, deoxidizer, desulfurizer; as a grain refiner in non-ferrous metals. Chemical intermediate for butyllithium polymerization catalyst; in alloys with aluminum or magnesium for aerospace uses. It is used in the production of tritium, reducing and hydrogenating agents, alloy hardeners, pharmaceuticals and Grignard reagents. Scavenger and degassifier for stainless and mild steels in molten state, modular iron, soaps and greases, deoxidizer in copper and copper alloys, heat-transfer liquid, storage batteries (with sulfur, selenium, tellurium, and chlorine). Rocket propellants, vitamin A synthesis, silver solders, underwater bouyancy devices, nuclear reactor coolent. HUMAN EXPOSURE AND TOXICITY: Elemental lithium causes severe eye and skin burns. Industrial exposures to lithium may occur during extraction of lithium from its ores, preparation of various lithium compounds, welding, brazing, enameling, and from the use of lithium hydrides. ANIMAL STUDIES: No animal studies could be located.

EMT Copyright Disclaimer. EMT = Emergency Medical Treatment
The information contained in the Truven Health Analytics Inc. products is intended as an educational aid only. All treatments or procedures are intended to serve as an information resource for physicians or other competent healthcare professionals performing the consultation or evaluation of patients and must be interpreted in view of all attendant circumstances, indications and contraindications. The use of the Truven Health Analytics Inc. products is at your sole risk. These products are provided “as is” and “as available” for use, without warranties of any kind, either express or implied. Truven Health Analytics Inc. makes no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, Truven Health ANALYTICS INC. makes no representation or warranties as to the opinions or other service or data you may access, download or use as a result of use of the Truven Health ANALYTICS INC. products. All implied warranties of merchantability and fitness for a particular purpose or use are hereby excluded. Truven Health Analytics Inc. does not assume any responsibility or risk for your use of the Truven Health Analytics Inc. products.The following Overview, *** CORROSIVES-ALKALINE ***, is relevant for this HSDB record chemical.

Life Support:
o This overview assumes that basic life support measures have been instituted.
Clinical Effects:
0.2.1 SUMMARY OF EXPOSURE 0.2.1.1 ACUTE EXPOSURE A) USES: Used as drain openers, household cleaners (oven, bathroom), hair relaxers, dishwasher soap, and in automobile air bags. In industry used as cleaners, in cement, and as chemical precursors. B) TOXICOLOGY: Alkaline corrosives cause liquefaction necrosis. They saponify the fats in the cell membrane, destroying the cell and allowing deep penetration into mucosal tissue. In gastrointestinal tissue an initial inflammatory phase may be followed by tissue necrosis (sometimes resulting in perforation), then granulation and finally stricture formation. C) EPIDEMIOLOGY: Exposure is common. Serious effects are rare in the developed world (generally only seen in adults with deliberate ingestion), largely because mostly low concentration corrosives are present in products available in the home. Serious effects are more common in developing countries. D) WITH POISONING/EXPOSURE 1) MILD TO MODERATE ORAL TOXICITY: Patients with mild ingestions may only develop irritation or grade I (superficial hyperemia and edema) burns of the oropharynx, esophagus or stomach; acute or chronic complications are unlikely. Patients with moderate toxicity may develop grade II burns (superficial blisters, erosions and ulcerations) are at risk for subsequent stricture formation, particularly esophageal. Some patients (particularly young children) may develop upper airway edema. a) Alkaline corrosive ingestion may produce burns to the oropharynx, upper airway, esophagus and occasionally stomach. Spontaneous vomiting may occur. The absence of visible oral burns does NOT reliably exclude the presence of esophageal burns. The presence of stridor, vomiting, drooling, and abdominal pain are associated with serious esophageal injury in most cases. b) PREDICTIVE: The grade of mucosal injury at endoscopy is the strongest predictive factor for the occurrence of systemic and GI complications and mortality. 2) SEVERE ORAL TOXICITY: May develop deep burns and necrosis of the gastrointestinal mucosa. Complications often include perforation (esophageal, gastric, rarely duodenal), fistula formation (tracheoesophageal, aortoesophageal), and gastrointestinal bleeding. Hypotension, tachycardia, tachypnea and, rarely, fever may develop. Stricture formation (esophageal, less often oral or gastric) is likely to develop long term. Esophageal carcinoma is another long term complication. Upper airway edema is common and often life threatening. Severe toxicity is generally limited to deliberate ingestions in adults in the US, because alkaline products available in the home are generally of low concentration. 3) INHALATION EXPOSURE: Mild exposure may cause cough and bronchospasm. Severe inhalation may cause upper airway edema and burns, stridor, and rarely acute lung injury. 4) OCULAR EXPOSURE: Ocular exposure can produce severe conjunctival irritation and chemosis, corneal epithelial defects, limbal ischemia, permanent visual loss and in severe cases perforation. 5) DERMAL EXPOSURE: Mild exposure causes irritation and partial thickness burns. Metabolic acidosis may develop in patients with severe burns or shock. Prolonged exposure or high concentration products can cause full thickness burns. 0.2.3 VITAL SIGNS


0.4.2 ORAL EXPOSURE A) MANAGEMENT OF MILD TO MODERATE ORAL TOXICITY 1) Perform early (within 12 hours) endoscopy in patients with stridor, drooling, vomiting, significant oral burns, difficulty swallowing or abdominal pain, and in all patients with deliberate ingestion. If burns are absent or grade I severity, patient may be discharged when able to tolerate liquids and soft foods by mouth. If mild grade II burns, admit for intravenous fluids, slowly advance diet as tolerated. Perform barium swallow or repeat endoscopy several weeks after ingestion (sooner if difficulty swallowing) to evaluate for stricture formation. B) SEVERE ORAL TOXICITY 1) Resuscitate with 0.9% saline; blood products may be necessary. Early airway management in patients with upper airway edema or respiratory distress. Early (within 12 hours) gastrointestinal endoscopy to evaluate for burns. Early bronchoscopy in patients with respiratory distress or upper airway edema. Early surgical consultation for patients with severe grade II or grade III burns, large deliberate ingestions, or signs, symptoms or laboratory findings concerning for tissue necrosis or perforation. C) DILUTION 1) Dilute with 4 to 8 ounces of water may be useful if it can be performed shortly after ingestion in patients who are able to swallow, with no vomiting or respiratory distress; then the patient should be NPO until assessed for the need for endoscopy. Neutralization, activated charcoal, and gastric lavage are all contraindicated. D) AIRWAY MANAGEMENT 1) Aggressive airway management in patients with deliberate ingestions or any indication of upper airway injury. E) ENDOSCOPY 1) Should be performed as soon as possible (preferably within 12 hours, not more than 24 hours) in any patient with deliberate ingestion, adults with any signs or symptoms attributable to inadvertent ingestion, and in children with stridor, vomiting, or drooling after inadvertent ingestion. Endoscopy should also be considered in children with dysphagia or refusal to swallow, significant oral burns, or abdominal pain after unintentional ingestion. Children and adults who are asymptomatic after inadvertent ingestion do not require endoscopy. The grade of mucosal injury at endoscopy is the strongest predictive factor for the occurrence of systemic and GI complications and mortality. The absence of visible oral burns does NOT reliably exclude the presence of esophageal burns. F) CORTICOSTEROIDS 1) The use of corticosteroids to prevent stricture formation is controversial. Corticosteroids should not be used in patients with grade I or grade III injury, as there is no evidence that it is effective. Evidence for grade II burns is conflicting, and the risk of perforation and infection is increased with steroid use. G) STRICTURE 1) A barium swallow or repeat endoscopy should be performed several weeks after ingestion in any patient with grade II or III burns or with difficulty swallowing to evaluate for stricture formation. Recurrent dilation may be required. Some authors advocate early stent placement in these patients to prevent stricture formation. H) SURGICAL MANAGEMENT 1) Immediate surgical consultation should be obtained on any patient with grade III or severe grade II burns on endoscopy, significant abdominal pain, metabolic acidosis, hypotension, coagulopathy, or a history of large ingestion. Early laparotomy can identify tissue necrosis and impending or unrecognized perforation, early resection and repair in these patients is associated with improved outcome. I) PATIENT DISPOSITION 1) OBSERVATION CRITERIA: Patients with alkaline corrosive ingestion should be sent to a health care facility for evaluation. Patients who remain asymptomatic over 4 to 6 hours of observation, and those with endoscopic evaluation that demonstrates no burns or only minor grade I burns and who can tolerate oral intake can be discharged home. 2) ADMISSION CRITERIA: Symptomatic patients, and those with endoscopically demonstrated grade II or higher burns should be admitted. Patients with respiratory distress, grade III burns, acidosis, hemodynamic instability, gastrointestinal bleeding, or large ingestions should be admitted to an intensive care setting. J) PITFALLS 1) The absence of oral burns does NOT reliably exclude the possibility of significant esophageal burns. 2) Patients may have severe tissue necrosis and impending perforation requiring early surgical intervention without having severe hypotension, rigid abdomen, or radiographic evidence of intraperitoneal air. 3) Patients with any evidence of upper airway involvement require early airway management before airway edema progresses. 4) The extent of eye injury (degree of corneal opacification and perilimbal whitening) may not be apparent for 48 to 72 hours after the burn. All patients with corrosive eye injury should be evaluated by an ophthalmologist. K) DIFFERENTIAL DIAGNOSIS 1) Acid ingestion, gastrointestinal hemorrhage, or perforated viscus. 0.4.3 INHALATION EXPOSURE A) DECONTAMINATION 1) Administer oxygen as necessary. Monitor for respiratory distress. B) AIRWAY MANAGEMENT 1) Manage airway aggressively in patients with significant respiratory distress, stridor or any evidence of upper airway edema. Monitor for hypoxia or respiratory distress. C) BRONCHOSPASM 1) Treat with oxygen, inhaled beta agonists and consider systemic corticosteroids. 0.4.4 EYE EXPOSURE A) DECONTAMINATION 1) Exposed eyes should be irrigated with copious amounts of 0.9% saline for at least 30 minutes, until pH is neutral and the cul de sacs are free of particulate material. 2) An eye examination should always be performed, including slit lamp examination. Ophthalmologic consultation should be obtained. Antibiotics and mydriatics may be indicated. 0.4.5 DERMAL EXPOSURE A) OVERVIEW 1) DECONTAMINATION a) Remove contaminated clothes and any particulate matter adherent to skin. Irrigate exposed skin with copious amounts of water for at least 15 minutes or longer, depending on concentration, amount and duration of exposure to the chemical. A physician may need to examine the area if irritation or pain persist.

A) LIQUID CORROSIVES – With highly concentrated liquids (30% sodium hydroxide) esophageal burns may occur in up to 100% of patients, even after accidental ingestion. B) Serious burns are less likely if the pH is less than 11.5. Injury is greater with large exposures and high concentrations. C) More recent series of caustic ingestions (mixed liquid and solid) in children report incidences of significant esophageal burns from 5% to 35%. Adults with deliberate ingestions are more likely to develop significant esophageal burns (30% to 80%). D) LOW PHOSPHATE DETERGENTS and electric dishwasher soaps may result in oral and esophageal burns.

EMT Copyright Disclaimer:  TRUHAVEN SALTS exclusive?
The information contained in the Truven Health Analytics Inc. products is intended as an educational aid only. All treatments or procedures are intended to serve as an information resource for physicians or other competent healthcare professionals performing the consultation or evaluation of patients and must be interpreted in view of all attendant circumstances, indications and contraindications. The use of the Truven Health Analytics Inc. products is at your sole risk. These products are provided “as is” and “as available” for use, without warranties of any kind, either express or implied. Truven Health Analytics Inc. makes no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, Truven Health ANALYTICS INC. makes no representation or warranties as to the opinions or other service or data you may access, download or use as a result of use of the Truven Health ANALYTICS INC. products. All implied warranties of merchantability and fitness for a particular purpose or use are hereby excluded. Truven Health Analytics Inc. does not assume any responsibility or risk for your use of the Truven Health Analytics Inc. products.The following Overview, *** LITHIUM SALTS ***, is relevant for this HSDB record chemical.


SUMMARY OF EXPOSURE 0.2.1.1 ACUTE EXPOSURE A) USES: Lithium carbonate is used therapeutically, primarily to treat bipolar disorder; it is less commonly used today due to the wide availability of other psychiatric medications with lesser side effects. It is available in oral formulations, both regular and extended release. Lithium orotate is a dietary supplement. Lithium is an important industrial material used to make batteries, alloys, and flux. B) PHARMACOLOGY: Lithium is a naturally occurring alkali metal and monovalent cation chemically similar to Na+ and K+. The exact mechanism by which it stabilizes mood is not known. It is thought to affect the CNS by altering nerve conduction, cortisol and monoamine metabolism, and increasing serotonin. C) TOXICOLOGY: In the kidney, lithium competes with Na+ and K+ in the renal tubules; conditions that increase renal sodium reabsorption (dehydration) decrease lithium elimination. Chronic toxicity is typically due to decreased clearance caused by dehydration, medication interactions, or renal impairment. D) EPIDEMIOLOGY: Acute poisoning is typically less severe than chronic toxicity. Chronic toxicity develops primarily in elderly patients, those with intercurrent illnesses, and those started on drugs that decrease lithium clearance. E) WITH THERAPEUTIC USE 1) At therapeutic doses, effects such as blurred vision, nystagmus, GI irritation, tremors, slowed mentation, cerebellar dysfunction may occur. Polyneuropathy and Parkinsonian syndrome have been described. ECG changes such as nonspecific ST/T changes, sinus node blocks may be present. Brugada Syndrome has been reported in several chronic lithium users. Nephrogenic Diabetes Insipidus, reduced glomerular filtration, and thyroid abnormalities, particularly hypothyroidism, may also occur. Lithium carbonate crosses the placenta and is also present in breast milk. Congenital malformations have been documented after exposure to lithium during pregnancy. 2) DRUG INTERACTIONS: Lithium clearance is decreased by concomitant use of ACE inhibitors, angiotensin II antagonists, thiazide and loop diuretics, and nonsteroidal anti-inflammatory drugs. F) WITH POISONING/EXPOSURE 1) MILD TO MODERATE POISONING: Toxicity is categorized as acute or chronic. Acute overdose is typically less severe than chronic toxicity and results in gastrointestinal upset, while CNS manifestations are less common due to slow absorption into the brain. Chronic effects are usually less gastrointestinal and more neurological due to prior CNS saturation. Mild to moderate poisoning can cause nausea, vomiting, diarrhea, dehydration, nystagmus, and tremors. Hyperreflexia, cogwheel rigidity, ataxia, agitation, confusion, and lethargy are common. Bradycardia, T-wave abnormalities, hypoventilation may also occur. 2) SEVERE POISONING: Severe effects in acute exposures are rare. Patients with chronic toxicity may manifest severe toxicity despite relatively modestly elevated serum lithium concentrations. Effects include photophobia, dehydration, electrolyte imbalances, thyroid dysfunction, hyperthermia, seizure, coma, rigidity, myoclonus, serotonin syndrome. ECG changes such as nonspecific T-wave abnormalities, QTc prolongation, bundle branch block, bradycardia, junctional rhythm, and hypotension may occur. Hypoventilation, respiratory failure, and ARDS may rarely develop. Bezoars may form in large ingestions. 0.2.3 VITAL SIGNS 0.2.20 REPRODUCTIVE HAZARDS A) Lithium is classified as FDA pregnancy category D. Congenital malformations have been reported. The use of lithium should be avoided during pregnancy, especially in the first trimester and one week prior to delivery. Cardiovascular and other teratogenic or toxic effects have been reported in infants born to lithium-treated mothers. In addition, a prospective, observational study showed that significantly more miscarriages and preterm deliveries occurred with lithium exposure during pregnancy (n=183) compared with a group of women who were not exposed to any teratogen during pregnancy (n=748). However, other studies have revealed that outcomes of most pregnancies with in utero exposure to lithium have resulted in normal infants, and that use of lithium during pregnancy may possess a lower fetal risk than previously believed. Lithium is present in breast milk at 33% to 50% of the plasma lithium concentration, and may cause hypertonia, hypothermia, cyanosis, and ECG changes in nursing infants and neonates. 0.2.21 CARCINOGENICITY 0.2.21.1 IARC CATEGORY A) IARC Carcinogenicity Ratings for CAS554-13-2 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): 1) Not Listed 0.2.21.2 HUMAN OVERVIEW A) At the time of this review, the manufacturer does not report any carcinogenic potential for lithium in humans. 0.2.22 GENOTOXICITY A) Lithium-treated patients did not demonstrate increased numbers of chromosomal lesions in blood lymphocytes compared with controls (Turecki et al, 1994).
Laboratory:
A) Monitor vital signs, mental status, and urine output. B) Serial lithium levels should be followed until concentration has clearly peaked and declined. The correlation between clinical toxicity and serum concentration is poor; an acute overdose is often asymptomatic despite high serum concentration; chronic exposure may have neurologic manifestations at therapeutic concentrations. C) Monitor electrolytes (particularly sodium), urinalysis, and serum creatinine. D) Obtain thyroid function tests and arterial blood gases; lithium intoxication may cause a low anion gap. E) CT scan of brain may be indicated if etiology of altered mentation is in question. Monitor EEG if there is a concern for subclinical seizures. Chest x-ray may be indicated to monitor pulmonary edema. In those with worsening symptoms or known large ingestions, closely monitor airway, breathing, circulation, cardiac ectopy via continuous cardiac monitoring (including pulse oximetry, capnography), and ECGs.
Treatment Overview:
0.4.2 ORAL EXPOSURE A) MANAGEMENT OF MILD TO MODERATE TOXICITY 1) Most acute lithium overdoses may be safely managed with supportive care that includes: antiemetics for nausea and vomiting, intravenous normal saline hydration to enhance renal lithium elimination, and correction of any electrolyte abnormalities. For chronic toxicity, address underlying causes of decreased renal clearance, including intravenous fluids for dehydration or ceasing medications that impair renal function. B) MANAGEMENT OF SEVERE TOXICITY 1) Orotracheal intubation for airway protection should be performed if recurrent seizures, increasing somnolence or coma develop. Consider gastric lavage for recent, large ingestion if airway is protected. Whole bowel irrigation with polyethylene glycol may be considered in large ingestions, especially if a sustained-release formulation. Administer intravenous normal saline to enhance renal elimination of lithium (Goal: urine output of 2 to 3 mL/kg/hr). Intravenous fluids and vasopressors (dopamine, norepinephrine) may be needed to treat hypotension. Treat agitation, rigidity, seizures, hyperthermia, serotonin syndrome with sedation (benzodiazepines, propofol), and cooling measures; intubation and paralysis may be necessary with severe toxicity. Consider hemodialysis for patients with severe toxicity not responding to hydration, or congestive heart failure or renal insufficiency. Dysrhythmias are treated with standard ACLS protocols. C) DECONTAMINATION 1) PREHOSPITAL: Charcoal does not adsorb lithium well; it is not recommended. 2) HOSPITAL: Consider gastric lavage in a patient with recent life-threatening ingestion, if airway is protected or patient is alert. Whole bowel irrigation with polyethylene glycol should be considered with a large ingestion or ingestion of a sustained-release product. D) AIRWAY MANAGEMENT 1) Intubate if unable to protect airway due to worsening agitation, somnolence or coma, or if respiratory distress develops. E) ANTIDOTE 1) None. F) ENHANCED ELIMINATION 1) Hemodialysis increases lithium clearance and decreases half-life. The decision to perform hemodialysis is largely clinical. The international expert Extracorporeal Treatments in Poisoning (EXTRIP) workgroup reviewed the available literature and despite a low quality of evidence recommended the following guidelines for extracorporeal treatment (ECTR) in patients with severe lithium toxicity with any of the following clinical conditions: a) In the presence of a reduced level of consciousness, seizures, or life-threatening dysrhythmias irrespective of lithium concentration. b) If kidney function is impaired and lithium concentration is greater than 4 mEq/L. 2) ECTR was also suggested for patients with any of the following clinical conditions: a) If lithium concentration is greater than 5 mEq/L, if confusion is present, or if the expected time to obtain a lithium concentration less than 1 mEq/L with optimal management is greater than 36 hours. 3) DISCONTINUATION of ECTR is recommended: a) In patients with apparent clinical improvement or lithium concentration less than 1 mEq/L. b) After a minimum of 6 hours of ECTR if the lithium concentration is not readily available. 4) Serum lithium levels typically rebound 6 to 12 hours after dialysis in chronically intoxicated patients due to equilibration with intracellular and CNS lithium stores. In order to determine the use of subsequent ECTR sessions, serial lithium concentrations should be determined over 12 hours after the cessation of ECTR. The preferred ECTR is intermittent hemodialysis, with an acceptable alternative being continuous renal replacement therapy (RRT), if intermittent hemodialysis is not available. Both continuous RRT and intermittent hemodialysis are equally acceptable after the first treatment. G) PATIENT DISPOSITION 1) HOME CRITERIA: Accidental ingestions in asymptomatic lithium naive patients who ingest less than the maximum daily dose (Children less than 6 years old: 900 mg/square meter/day; Children 6 to 12 years old: 30 mg/kg/day; Adults: less than 2400 mg) who have no synergistic co-ingestions may be monitored at home. Those chronically taking lithium that are accidentally exposed to additional doses needed to be evaluated on a case by case basis, but typically tolerate a double dose without significant effects. 2) OBSERVATION CRITERIA: Patients with deliberate ingestions, symptomatic patients, children and adults with ingestions of greater than maximum daily dose, acute-on-chronic ingestions, unknown dosing errors in chronic patients, synergistic co-ingestions, or those with unclear history should be sent to a health care facility for evaluation and observation. Patients should be monitored until serum lithium concentration has peaked and is consistently declining and clinical condition is improved. 3) ADMISSION CRITERIA: Patients with persistent or worsening gastrointestinal irritation, renal impairment, altered mentation, respiratory depression, dysrhythmias, unstable vital signs, or persistently rising serum lithium concentrations should be admitted. Intensive care admission is indicated for aggressive airway, cardiac monitoring, and emergent hemodialysis. 4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing patients with severe toxicity (agitation, hyperthermia, need for hemodialysis, respiratory depression, coma), concerns about decontamination, or in whom the diagnosis is not clear. Consult a nephrologist for emergent hemodialysis in patients with severe poisoning. H) PITFALLS 1) Patients with chronic toxicity often exhibit neurologic toxicity at levels lower than those with acute exposures. Close monitoring of electrolytes, renal function, urine output, neurologic exam, mental status, and temperature should be correlated with serial levels to assess efficacy of treatment. Anticipate early the need to transfer the patient to a higher level of care if unable to check serial lithium concentration, or if hemodialysis is not available. Diuretics should be avoided as they increase lithium reabsorption in the renal tubules. I) PHARMACOKINETICS 1) Well absorbed; peak concentrations within 2 to 5 hours. Lithium is not bound to plasma proteins. The volume of distribution is 0.79 L/kg. Primarily renal (8% to 98%) elimination. Initial half-life is 6 to 12 hours, slowing to 24 hours or greater due to slow redistribution from intracellular compartment. Nearly 80% of filtered lithium is reabsorbed in proximal tubule; reabsorption increases with sodium depletion or dehydration. Half-life in therapeutic dose is approximately 19 hours (14 to 24 hours). J) TOXICOKINETICS 1) Peak lithium concentrations delayed 4 to 17 hours after overdose of sustained release formulations. Half-life is shorter in acute overdose (10 to 20 hours) and prolonged in patients with chronic intoxication (mean 32 hours). Hemodialysis reduces half-life to 2 to 5 hours. Serum concentrations rebound after hemodialysis due to redistribution from intracellular compartments. K) DIFFERENTIAL DIAGNOSIS 1) Extrapyramidal effects from other medications, neuroleptic malignant syndrome, serotonin syndrome from other agents, sepsis, CNS infections, or intracranial catastrophes (massive hemorrhage or stroke).
Range of Toxicity:
A) TOXICITY: Toxic dose is not well defined. In some patients on chronic lithium therapy, the serum concentrations associated with toxic effects are close to therapeutic levels. Therapeutic concentration is 0.6 to 1.2 mEq/L. CHRONIC VS ACUTE: Acute poisoning is typically less severe than chronic for a given serum concentration. Mild to moderate toxic reactions may occur at 1.2 to 2.5 mEq/L in chronic intoxications. Patients with chronic toxicity and serum concentrations above 2.5 mEq/L may have more severe effects, and serum concentrations above 4 mEq/L are generally associated with severe CNS effects in patients with chronic toxicity. Patients with an acute lithium toxicity can develop high serum concentrations with limited distribution to the brain (which can be delayed up to 24 hours), and limited neurologic toxicity. Conversely, in patients on chronic therapy the serum lithium concentration is closer to steady state and correlates better with brain lithium levels. B) ADULTS: A 45-year-old man died after an acute ingestion of 90 sustained-release lithium tablets (450 mg each) with a peak level of 6.9 mEq/L despite hemodialysis. A 28-year-old man survived an acute ingestion with a lithium level of 10 mEq/L. An adult recovered after an acute ingestion of 84 grams (210 tablets of 400 mg) of lithium. Levels up to 14 mmol/L have been recorded in survivors of acute ingestions. PEDIATRIC: Accidental ingestions of an average of 2 pills typically causes drowsiness, while neurotoxicity has resulted after chronic therapy of 40 mg/kg/day. Mortality due to lithium as a single exposure is rare if recognized quickly and treated aggressively. C) Full recovery was reported after a 39-year-old man ingested 210 lithium carbonate tablets (400 mg each) following a suicide attempt. D) THERAPEUTIC DOSE: ADULT: Daily dose ranges from 600 to 2400 mg. PEDIATRIC: EXTENDED-RELEASE TABLETS: 12 YEARS OF AGE AND OLDER: The recommended dose is 900 to 1800 mg/day orally in 2 to 4 divided doses. IMMEDIATE-RELEASE AND CAPSULES: 12 YEARS OF AGE AND OLDER: maintenance, 300 mg orally 3 to 4 times daily; desired serum lithium levels ranging between 0.6 to 1.2 mEq/L. YOUNGER THAN 12 YEARS OF AGE: Safety and effectiveness have not been established.


Antidote and Emergency Treatment:
    Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary … . Monitor for shock and treat if necessary … . Anticipate seizures and treat if necessary … . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during treatment … . Do not use emetics. For ingestion, rinse mouth and administer 5 ml/kg up to 200 ml of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool … . Cover skin burns with dry sterile dressings after decontamination … . /Lithium and related compounds/[Currance, P.L. Clements, B., Bronstein, A.C. (Eds).; Emergency Care For Hazardous Materials Exposure. 3Rd edition, Elsevier Mosby, St. Louis, MO 2005, p. 398-90] **PEER REVIEWED**Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag-valve-mask device may be beneficial. Consider drug therapy for pulmonary edema … . Monitor cardiac rhythm and treat arrhythmias if necessary … . Start IV administration of D5W /SRP: “To keep open”, minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer’s (LR) if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Consider vasopressors if patient is hypotensive with a normal fluid volume. Watch for signs of fluid overload … . Treat seizures with diazepam or lorazepam … . Use proparacaine hydrochloride to assist eye irrigation … . /Lithium and related compounds/[Currance, P.L. Clements, B., Bronstein, A.C. (Eds).; Emergency Care For Hazardous Materials Exposure. 3Rd edition, Elsevier Mosby, St. Louis, MO 2005, p. 399] **PEER REVIEWED**Ingestion of lithium metal … is caustic. Dilution with water or other water-containing materials may produce a reaction that exacerbates the corrosive activity. Consideration may be given to gastric lavage with a large diameter tube for removal of material and then dilution with large amounts of water. Esophagoscopy may be of assistance in this procedure and to assess extent of damage. Treatment is otherwise symptomatic and supportive. Administration of activated charcoal is not useful because it does not bind to lithium ions and obscures endoscopic findings[Dart, R.C. (ed). Medical Toxicology. Third Edition, Lippincott Williams & Wilkins. Philadelphia, PA. 2004., p. 1433] **PEER REVIEWED**


Bionecessity:
    No physiological function has been reported for Li.[Chang, L.W. (ed.). Toxicology of Metals. Boca Raton, FL: Lewis Publishers, 1996, p. 455] **PEER REVIEWED**
Environmental Fate & Exposure:

Environmental Fate/Exposure Summary:
    Lithium is widely distributed in nature; trace amounts are found in many minerals, in most rocks and soils, and in many natural waters. Lithium is a member of the alkali metals and does not occur as the free metal in nature. Lithium concentrations in the earth’s crust are estimated to be 20 to 70 ppm by weight; it is the 27th most abundant element. Lithium is found in small amounts in nearly all igneous rocks and in the waters of many mineral springs. Lepidolite, spodumene, petalite, and amblygonite are the most important lithium containing minerals. The production and use of lithium compounds in ceramics, glass and primary aluminum production, the manufacture of lubricants and greases, primary and secondary (rechargeable) batteries, the production of synthetic rubber, the manufacture of polyester fiber, the production of antioxidants and antihistamines, as catalysts, and in the treatment of mood disorders may result in the release of lithium compounds to the environment through various waste streams. If release to air lithium compounds should exist in the particulate phase in the ambient atmosphere since the ionic nature of lithium compounds makes them essentially non-volatile. Particulate-phase lithium may be physically removed from the air by wet and dry deposition. The adsorption of lithium was measured on aquifer material; Freundlich coefficients ranged from 4.5 to 5.5. Lithium has been found to sorb slightly to humic soils with a Kp of 4.6 at pH 5. These data indicate that lithium compounds are not expected to adsorb strongly to soils and sediments. Lithium ion would not be expected to undergo oxidation-reduction reactions under environmental conditions, and would exist in its +1 oxidation state either in compounds or as dissolved ions. The ionic nature of lithium compounds makes them essentially non-volatile; lithium compounds would not volatilized from dry soil surfaces. Due to the ionic nature of lithium compounds, volatilization from moist surfaces will not occur. In water, adsorption to suspended solids and sediments is not expected to be important fate processes for lithium compounds. Lithium ions may undergo precipitation, sorption, or ligand exchange reactions in the environment. Due to the ionic nature of most lithium compounds, volatilization from water surfaces will not occur. Bioconcentration is not expected to be an important fate process due to the ionic nature of lithium compounds. Occupational exposure to lithium compounds may occur through inhalation and dermal contact at workplaces where lithium compounds are produced or used. Since lithium is found various environmental media, the general public would be exposed to small amounts of lithium via inhalation of ambient air, ingestion of food and drinking water. (SRC)**PEER REVIEWED**
Probable Routes of Human Exposure:
    NIOSH (NOES Survey 1981-1983) has statistically estimated that 3,455 workers (1,084 of these are female) are potentially exposed to lithium in the US(1).[(1) NIOSH; International Safety Cards. Lithium. CAS No. 7439-93-2 Available at http://www.cdc.gov/niosh/ipcs/nicstart.html as of Jan 12, 2007.] **PEER REVIEWED**Industrial exposures to lithium may occur during extraction of lithium from its ores, preparation of various lithium compounds, welding, brazing, enameling, and from the use of lithium hydrides. /Lithium/[Clayton, G.D., F.E. Clayton (eds.) Patty's Industrial Hygiene and Toxicology. Volumes 2A, 2B, 2C, 2D, 2E, 2F: Toxicology. 4th ed. New York, NY: John Wiley & Sons Inc., 1993-1994., p. 2C: 2088] **PEER REVIEWED**
Natural Pollution Sources:
    Lithium is widely distributed in nature; trace amounts are found in many minerals, in most rocks and soils, and in many natural waters(1). Lithium is a member of the alkali metals and does not occur as the free metal in nature(2). The typical oxidation state of the alkali metals is +1; no other cations are known or expected for the alkali metals(4). Lithium concentrations in the earth’s crust are estimated to be 20 to 70 ppm by weight(1); it is the 27th most abundant element(3). Lithium is found in small amounts in nearly all igneous rocks and in the waters of many mineral springs(2). Lepidolite, spodumene, petalite, and amblygonite are the most important lithium containing minerals(2).[(1) Kamienski CW; Kirk-Othmer Encycl Chem Technol. 4th ed. NY, NY: John Wiley & Sons, 15: 434-463 (1995) (2) Lide DR; CRC Handbook of Chemistry and Physics 86th ed, CRC Press, Inc p. 4-21 (2005) (3) Bauer RJ; Ullmann's Encycl Indust Chem, 5th ed., Deerfield Beach, FL: VCH Publ. VA15: 393-414 (1990) (4) Cotton FA, Wilkinson G, Murillo, CA, Bochmann, M; Advanced Inorganic Chemistry 6th edition. NY, NY: John Wiley and Sons, pp.92-110 (1999)] **PEER REVIEWED**
Chemical/Physical Properties:

Molecular Formula:
    Li**PEER REVIEWED**
Molecular Weight:
    6.941[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Color/Form:
Soft silvery-white metal
[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Silvery-white metal; body centered cubic structure; becomes yellowish on exposure to moist air
[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. 13th Edition, Whitehouse Station, NJ: Merck and Co., Inc., 2001., p. 990] **PEER REVIEWED**

Odor:
ODORLESS
[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**

Boiling Point:
    1342 deg C[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Melting Point:
    180.54 deg C[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Corrosivity:
    LIQUID METAL IS CORROSIVE, ATTACKING GLASS OR PORCELAIN AT A TEMPERATURE OF ABOUT 200 DEG C[Browning, E. Toxicity of Industrial Metals. 2nd ed. New York: Appleton-Century-Crofts, 1969., p. 200] **PEER REVIEWED**Emits corrosive fumes when burned[Association of Official Analytical Chemists. Official Methods of Analysis. 15th ed. and Supplements. Washington, DC: Association of Analytical Chemists, 1990, p. 651] **PEER REVIEWED**
Critical Temperature & Pressure:
    Critical temperature = 3223 deg C; critical pressure = 68.9 MPa[Gerhartz, W. (exec ed.). Ullmann's Encyclopedia of Industrial Chemistry. 5th ed.Vol A1: Deerfield Beach, FL: VCH Publishers, 1985 to Present., p. VA15: 395 (1990)] **PEER REVIEWED**
Density/Specific Gravity:
    0.534 g/cu cm at 25 deg C[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Heat of Combustion:
    -18,470 BTU/LB= -10,260 CAL/G= -429.3X10+5 J/KG[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**
Heat of Vaporization:
    ca. 21.3 kJ/g[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Solubilities:
Reacts with water
[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-69] **PEER REVIEWED**
Soluble in liquid ammonia forming a blue solution
[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. 13th Edition, Whitehouse Station, NJ: Merck and Co., Inc., 2001., p. 990] **PEER REVIEWED**

Spectral Properties:
Emits characteristic crimson color (670.8 nm) in flame
[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. 13th Edition, Whitehouse Station, NJ: Merck and Co., Inc., 2001., p. 990] **PEER REVIEWED**
Characteristic spectrum lines: 670.8 nm (red); 610.4 (orange)
[Kirk-Othmer Encyclopedia of Chemical Technology. 4th ed. Volumes 1: New York, NY. John Wiley and Sons, 1991-Present., p. VA15: 443 (1995)] **PEER REVIEWED**

Surface Tension:
    Surface tension at the melting point: 398 mN/m[Gerhartz, W. (exec ed.). Ullmann's Encyclopedia of Industrial Chemistry. 5th ed.Vol A1: Deerfield Beach, FL: VCH Publishers, 1985 to Present., p. V15: 394 (1990)] **PEER REVIEWED**
Vapor Pressure:
    7.90X10-11 Pa (5.92X10-13 mm Hg) at 400 K (127 deg C); 0.000489 Pa (3.67X10-6 mm Hg) at 600 K (327 deg C); 1.08 Pa (0.00810 mm Hg) at 800 K (524 deg C); 109 Pa (0.818 mm Hg) at 1000 K (727 deg C)[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 4-130] **PEER REVIEWED**
Other Chemical/Physical Properties:
Atomic number: 3; valance: 1; group IA(1); alkali metal; hardest of the alkali metals; Mohs’ hardness: 0.6; Oxidation potential: 3.045 V; reacts with water forming the hydroxide and hydrogen (H2); reacts violently with inorganic acids; reacts slowly with cold sulfuric acid; does not react with oxygen at room temperature; forms Li2O when heated to 100 deg C or higher; artificial radioactive isotopes: 5, 8-11 (all are unstable, half-lives < 1 sec)
[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. 13th Edition, Whitehouse Station, NJ: Merck and Co., Inc., 2001., p. 990] **PEER REVIEWED**
Two stable isotopes are present in natural lithium: 7 (92.4%); 6 (7.6%); remains untarnished in dry air, but in moist air, its surface becomes coated with a mixture of LiOH, LiOH.H2O, Li2CO3, Li3N; thin films are opaque to visible light, but are transparent to UV radiation; electrical resistivity at 20 deg C: 9.446 microohm cm; first ionization potential: 519 kJ/mol; electron affinity: 52.3 kJ/mol
[Kirk-Othmer Encyclopedia of Chemical Technology. 4th ed. Volumes 1: New York, NY. John Wiley and Sons, 1991-Present., p. V15: 442 (1995)] **PEER REVIEWED**
Enthalpy of fusion at the melting point: 432 J/g; specific heat capacity at constant pressure at 25 deg C: 3.57 24.8 J/mol K
[Lide, D.R. CRC Handbook of Chemistry and Physics 86TH Edition 2005-2006. CRC Press, Taylor & Francis, Boca Raton, FL 2005, p. 12-196] **PEER REVIEWED**
When heated above melting point it burns with an intense white light; liquid metal dissolves metals such as copper, zinc, tin and their alloys.
[Browning, E. Toxicity of Industrial Metals. 2nd ed. New York: Appleton-Century-Crofts, 1969., p. 200] **PEER REVIEWED**
Lightest and least reactive of the alkali metals; lightest solid element; reacts exothermically with nitrogen in moist air at high temperatures; high electrical conductivity
[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**
Heat of solution: -31,500 btu/lb= -17,500 cal/g= -733X10+5 J/kg
[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**
Critical volume: 66 mL/mol
[Gerhartz, W. (exec ed.). Ullmann's Encyclopedia of Industrial Chemistry. 5th ed.Vol A1: Deerfield Beach, FL: VCH Publishers, 1985 to Present., p. VA15: 395 (1990)] **PEER REVIEWED**
Highly electropositive; high ionization potential; does not generally form coordinate covalent compounds.
[Venugopal, B. and T.D. Luckey. Metal Toxicity in Mammals, 2. New York: Plenum Press, 1978., p. 4] **PEER REVIEWED**
Decomposes in alcohol
[Clayton, G. D. and F. E. Clayton (eds.). Patty's Industrial Hygiene and Toxicology: Volume 2A, 2B, 2C: Toxicology. 3rd ed. New York: John Wiley Sons, 1981-1982., p. 1731] **PEER REVIEWED**
Burns with a luminous white flame, forming a dense white smoke consisting of mainly lithium oxide
[Gerhartz, W. (exec ed.). Ullmann's Encyclopedia of Industrial Chemistry. 5th ed.Vol A1: Deerfield Beach, FL: VCH Publishers, 1985 to Present., p. VA15: 395 (1990)] **PEER REVIEWED**
Violently reactive with water or moisture, carbon dioxide, halogens, strong acids, and chlorinated hydrocarbons.
[Association of Official Analytical Chemists. Official Methods of Analysis. 15th ed. and Supplements. Washington, DC: Association of Analytical Chemists, 1990, p. 651] **PEER REVIEWED**
Viscosity of liquid lithium is less than water
[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**

Chemical Safety & Handling:

DOT Emergency Guidelines:
    /GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Fire or Explosion: Produce flammable gases on contact with water. May ignite on contact with water or moist air. Some react vigorously or explosively on contact with water. May be ignited by heat, sparks or flames. May re-ignite after fire is extinguished. Some are transported in highly flammable liquids. Runoff may create fire or explosion hazard.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Health: Inhalation or contact with vapors, substance or decomposition products may cause severe injury or death. May produce corrosive solutions on contact with water. Fire will produce irritating, corrosive and/or toxic gases. Runoff from fire control may cause pollution.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Public Safety: CALL Emergency Response Telephone Number on Shipping Paper first. If Shipping Paper not available or no answer, refer to appropriate telephone number listed on the inside back cover. As an immediate precautionary measure, isolate spill or leak area in all directions for at least 50 meters (150 feet) for liquids and at least 25 meters (75 feet) for solids. Keep unauthorized personnel away. Stay upwind. Keep out of low areas. Ventilate the area before entry.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Protective Clothing: Wear positive pressure self-contained breathing apparatus (SCBA). Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection. Structural firefighters’ protective clothing provides limited protection in fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Evacuation: Spill: See Table 1 – Initial Isolation and Protective Action Distances for highlighted materials. For non-highlighted materials, increase, in the downwind direction, as necessary, the isolation distance shown under “PUBLIC SAFETY”. Fire: If tank, rail car or tank truck is involved in a fire, ISOLATE for 800 meters (1/2 mile) in all directions; also, consider initial evacuation for 800 meters (1/2 mile) in all directions.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Fire: DO NOT USE WATER OR FOAM. Small Fire: Dry chemical, soda ash, lime or sand. Large Fire: DRY sand, dry chemical, soda ash or lime or withdraw from area and let fire burn. Move containers from fire area if you can do it without risk. Fire Involving Metals or Powders (Aluminum, Lithium, Magnesium, etc.): Use dry chemical, DRY sand, sodium chloride powder, graphite powder or Met-L-X powder; in addition, for Lithium you may use Lith-X powder or copper powder. Also, see GUIDE 170. Fire involving Tanks or Car/Trailer Loads: Fight fire from maximum distance or use unmanned hose holders or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tank. ALWAYS stay away from tanks engulfed in fire.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ Spill or Leak: ELIMINATE all ignition sources (no smoking, flares, sparks or flames in immediate area). Do not touch or walk through spilled material. Stop leak if you can do it without risk. Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact spilled material. DO NOT GET WATER on spilled substance or inside containers. Small Spill: Cover with DRY earth, DRY sand or other non-combustible material followed with plastic sheet to minimize spreading or contact with rain. Dike for later disposal; do not apply water unless directed to do so. Powder Spill: Cover powder spill with plastic sheet or tarp to minimize spreading and keep powder dry. DO NOT CLEAN-UP OR DISPOSE OF, EXCEPT UNDER SUPERVISION OF A SPECIALIST.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**/GUIDE 138 SUBSTANCES – WATER-REACTIVE (Emitting Flammable Gases)/ First Aid: Move victim to fresh air. Call 911 or emergency medical service. Give artificial respiration if victim is not breathing. Administer oxygen if breathing is difficult. Remove and isolate contaminated clothing and shoes. In case of contact with substance, wipe from skin immediately; flush skin or eyes with running water for at least 20 minutes. Keep victim warm and quiet. Ensure that medical personnel are aware of the material(s) involved and take precautions to protect themselves.[U.S. Department of Transportation. 2012 Emergency Response Guidebook. Washington, D.C. 2012] **QC REVIEWED**
Fire Potential:
    … Flammable solid.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**Molten Li is… difficult to extinguish.[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**Reacts violently /with water/ to form hydrogen gas and strong caustic solution. Ignition usually occurs.[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**If lithium metal is heated to its melting point, spontaneous ignition is likely.[Association of American Railroads. Emergency Handling of Hazardous Materials in Surface Transportation. Washington, DC: Association of American Railroads, Bureau of Explosives, 1994., p. 652] **PEER REVIEWED**Lithium is spontaneously flammable in air if heated to 180 deg C, if the surface of the metal is clean …[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-108] **PEER REVIEWED**Finely divided metal may ignite in air at ambient temperature and /a large mass of/ metal above the melting point, 180 deg C, especially if oxide or nitride is present.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1312] **PEER REVIEWED**
Fire Fighting Procedures:
    Extinguish lithium fires only with chemicals designed for this purpose.[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 674] **PEER REVIEWED**Use approved Class D extinguishers or smother with dry sand, dry clay, or dry ground limestone. DO NOT use carbon dioxide or halogenated extinguishing agents. DO NOT use water. Violent reaction may result.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**If material on fire or involved in fire: Do not use water. Do not use carbon dioxide. Use graphite, soda ash, powdered sodium chloride, or suitable dry powder.[Association of American Railroads; Bureau of Explosives. Emergency Handling of Hazardous Materials in Surface Transportation. Association of American Railroads, Pueblo, CO. 2005, p. 535] **PEER REVIEWED**Powdered graphite, lithium chloride, potassium chloride or zirconium silicate are suitable extinguishants.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1312] **PEER REVIEWED**
Toxic Combustion Products:
    Combustion may produce irritants and toxic gases.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-92] **PEER REVIEWED**
Firefighting Hazards:
    Corrosive … Water reactive … Evolves hydrogen and ignites on contact with water.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**Sodium carbonate and sodium chloride are unsuitable to use as extinguishers for lithium fires, since burning lithium will liberate the more reactive sodium in contact with them.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1317] **PEER REVIEWED**Liquid lithium is readily ignited and reacts with most extinguishing agents, including water, carbon tetrachloride and carbon dioxide.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-110] **PEER REVIEWED**Since lithium will burn in oxygen, nitrogen or carbon dioxide, and when alight it will remove the combined oxygen in sand, sodium carbonate, etc., it is difficult to extinguish once alight … Use of normal fire extinguishers (containing water, form, carbon dioxide, halocarbons, dry powders) will either accelerate combustion or cause explosion.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1312] **PEER REVIEWED**
Explosive Limits & Potential:
    … Atmospheric oxidation of molten lithium led to an explosion. A high degree of correlation of incidence of explosions with high atmospheric humidity was demonstrated, with the intensity of explosion apparently directly related to the purity of the sample of metal.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1312] **PEER REVIEWED**… The powdered metal reacts explosively with water … Prolonged contact with steam forms a thermally insulating layer which promotes overheating of the metal and may lead to a subsequent explosion as the insulating layer breaks up.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1318] **PEER REVIEWED**
Hazardous Reactivities & Incompatibilities:
    Reacts with water forming lithium hydroxide and hydrogen. Keep under mineral oil or other liquid free from oxygen or water.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 203] **PEER REVIEWED**Water. Powdered metal reacts explosively; shavings react violently with hot water, … vigorously with cold water.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 203] **PEER REVIEWED**Platinum and molten lithium react violently at 540 deg C plus or minus 20 deg C. An intermetallic cmpd is formed.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**In electric battery systems, lithium is inert to the electrolyte components in absence of carbon, but in presence of over 10% of carbon (pre-mixed by grinding with the metal), contact with the electrolyte mixture leads to ignition or explosion … Pregrinding lithium with carbon leads to ignition on contact with sulfinyl chloride in electric battery systems.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1313] **PEER REVIEWED**Reduction of tetralin to octalin with lithium and ethylenediamine proceeds slowly, but if heated to 85 deg C it becomes violent, with rapid evolution of hydrogen.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1314] **PEER REVIEWED**Finely divided metal may ignite in air at ambient temperature and massive metal above the m.p., 180 deg C, especially if oxide or nitride is present. … Lithium will burn in oxygen, nitrogen or carbon dioxide, and when alight it will remove the combined oxygen in sand, sodium carbonate, etc., it is difficult to extinguish once alight. Molten lithium is extremely reactive and will attack concrete and refractory materials … A well-tried and usually uneventful demonstration of atmospheric oxidation of molten lithium led to an explosion. A high degree of correlation of incidence of explosions with high atmospheric humidity was demonstrated, with the intensity of explosion apparently directly related to the purity of the sample of metal … While cleaning lithium wire by washing with hexane, the wire must be dried carefully with a paper towel. Too-vigorous rubbing will cause a fire.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1312] **PEER REVIEWED**… Mixtures of carbon disulfide with … lithium are capable of detonation by shock, though not by heating.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 197] **PEER REVIEWED**Accidental contamination of lithium strip with anhydrous chromium trichloride or zirconium tetrachloride caused it to ignite and burn vigorously in the nitrogen atmosphere of a glove box.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1315] **PEER REVIEWED**When 15 mL of nitric acid were poured onto 15 g of lithium in an attempt to dissolve the metal, a small fire started in the flask. In less than a minute, the reaction was so vigorous that burning lithium was thrown upward in the lab hood.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**Vigorous stirring of finely powdered lithium in bromobenzene resulted in an explosion.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 203] **PEER REVIEWED**In a modified prepn of phenyllithium, bromobenzene was added to finely powdered lithium (rather than coarse particles) in ether. The reaction appeared to be proceeding normally, but after about 30 min it became very vigorous and accelerated to explosion. It was thought that the powdered metal may have been partially coated with oxide or nitride which abraded during stirring, exposing a lot of fresh metal surface on the powdered metal.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1313] **PEER REVIEWED**Halogens. Mixtures with bromine explode only on heavy impact; mixtures with iodine are highly exothermic above 200 deg C.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 203] **PEER REVIEWED**Lithium burns in gaseous hydrogen.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**The reaction of lithium is violent with both strongly heated arsenic and phosphorus.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-108] **PEER REVIEWED**Lithium will burn in air, oxygen, nitrogen, and carbon dioxide. The susceptibility of molten lithium surfaces to spontaneous ignition is increased by the presence of lithium oxides or nitrides. These reactions and the reaction with water are extremely violent at higher temperatures. Contact with halogenated hydrocarbons can produce extremely violent reactions, especially on impact … The reaction of lithium and nitrogen incr greatly as the metal melts.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**Evolves hydrogen and ignites on contact with water.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**The product of the reaction between lithium and carbon monoxide, lithium carbonyl, detonates violently with water, igniting gaseous products.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-108] **PEER REVIEWED**Chlorine vapors and cesium, lithium, or rubidium react with luminous flame.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-47] **PEER REVIEWED**Diborane reacts spontaneously with aluminum and lithium to form hydrides that ignite in air.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-14] **PEER REVIEWED**Maleic anhydride decomp explosively in the presence of alkali metals /eg, lithium/.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-11] **PEER REVIEWED**Sodium chloride extinguishant should not be used on lithium fires since the reaction releases sodium and results in a more violent fire.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**Lithium reacts with sodium nitrite to form lithium sodium hydronitrite, a cmpd which decomp violently around 100 to 130 deg C.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**Interaction /of lithium and sulfur/ when either is molten is very violent and, even in presence of inert diluent, the reaction begins explosively. Reaction of sulfur with lithium dissolved in liq ammonia at -33 deg C is also very vigorous.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1317] **PEER REVIEWED**Interaction to form lithium amalgam is violently exothermic and may be explosive if large pieces of lithium are used.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1315] **PEER REVIEWED**Lithium blocks containing traces of nitride but which had been supplied under argon in sealed tins were cut into 1 cm strips and stored under air in closed tins overnight until used. Lithium containing some nitride reacts slowly with nitrogen at ambient temp to form more nitride, which autocatalyses the reaction which progressively accelerates and becomes exothermic. The strips of lithium reacted with the nitrogen of the air in the closed tins, causing a partial vacuum and an oxygen-enriched atmosphere. When the tins collapsed, the impact and/or compression of the oxygen-enriched atmosphere caused ignition and fierce burning of the lithium, which was very difficult to extinguish inside the crushed tins.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1313] **PEER REVIEWED**/Bromine pentafluoride/ contacts with … /lithium powder/ at ambient or slightly elevated temp is violent, ignition often occurring …[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 93] **PEER REVIEWED**Interaction of lithium or calcium with chlorine tri- or penta-fluorides is hypergolic and particularly energetic.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 944] **PEER REVIEWED**The preparation of 1-lithio-3-dimethylaminopropane … involved reaction of the chloro cmpd with a mineral oil dispersion of lithium (30%) in hexane at 0 deg. It had previously been found that lithium with a sodium content of some 0.3% reacted slowly, even at temp above 15 deg C. When a new batch of lithium (later found to contain 1.9% of sodium) was used, a vigorous reaction which set in at between 0 and -35 deg C led to ignition of the reaction mixture. Although it was known that the presence of sodium incr the reactivity of lithium towards organohalides up to a sodium content of 2%, it had not been appreciated that such wide variations in reactivity were likely, or that a hazardous situation could develop. However, a more likely cause proposed for the runaway exothermic reaction was the fact that all the reagents were mixed at 0 deg C, rather than the more usual course of adding the halide slowly to the lithium dispersion in a hydrocarbon solvent lower-boiling than hexane, so as to maintain gentle reflux at 35 to 50 deg C …[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1314] **PEER REVIEWED**Contact of diazomethane with alkali metals causes explosions[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 147] **PEER REVIEWED**Mixtures of lithium shavings and several halocarbon derivatives are impact-sensitive and will explode, sometime violently. Such materials include: bromoform, carbon tetrabromide, carbon tetrachloride, carbon tetraiodide, chloroform, dichloromethane, diiodomethane, fluorotrichloromethane, tetrachloroethylene, trichloroethylene and 1,1,2-trichlorotrifluoroethane. In an operational incident shearing samples off a lithium billet immersed in carbon tetrachloride caused an explosion and continuing combustion of the immersed metal. Lithium which had been washed in carbon tetrachloride to remove traces of oil exploded when cut with a knife. Hexane is recommended as a suitable washing solvent. A few drops of carbon tetrachloride on burning lithium was without effect, but a 25 cc portion caused a violent explosion.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1315] **PEER REVIEWED**Interaction /of lithium and mercury/ to form lithium amalgam is violently exothermic and may be explosive if large pieces of lithium are used. An improved technique, using p-cymene as inerting diluent, is described …[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1315] **PEER REVIEWED**Lithium is used to reduce metallic oxides in metallurgical operations, and the reactions, after initiation at moderate temp, are violently exothermic and rapid. Chromium(III) oxide reacts at 185 deg C, reaching 965 deg; similarly molybdenum trioxide (180 to 1400 deg), niobium pentoxide (320 to 490 deg), titanium dioxide (200 to 400 to 1400 deg), tungsten trioxide (200 to 1030 deg), vanadium pentoxide (394 to 768 deg); also iron(II) sulfide (260 to 945 deg), and manganese telluride (230 to 600 deg). Residual mixtures from lithium production cells containing lithium and rust sometime ignite when left as thin layers exposed to air.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1316] **PEER REVIEWED**Formation of various intermetallic cmpd of lithium by melting with aluminium, bismuth, calcium, lead, mercury, silicon, strontium, thallium or tin may be very vigorous and dangerous to effect. Ignition and combustion hazards of alloys of lithium with aluminium or magnesium have been studied. the latter being more reactive than the former. Use of nitrogen as a protective medium for alloy powders is ineffective, mixed nitrides being formed.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1316] **PEER REVIEWED**Mixtures of finely divided metal and shredded polymer /of poly(1,1-difluoroethylene-hexafluoropropylene) (Viton)/ ignited in air on contact with water, or on heating to 369 deg C, or at 354 deg C under argon.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1317] **PEER REVIEWED**An experimental investigation of explosion hazards in lithium-sulfinyl chloride cells on forced discharge showed cathode limited cells are safe, but anode limited cells may explode without warning signs. Extended reversal at -40 deg C caused explosion on warming to ambient temp, owing to thermal runaway caused by accelerated corrosion of lithium. The violent explosion of a large prismatic cell of a battery is described.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1317] **PEER REVIEWED**Two reports cover safety studies on lithium-sulfur dioxide batteries. The cause of violent venting of discharged lithium-sulfur dioxide cells was ascribed to corrosion in a glass to metal seal and formation of lithium-aluminium alloys and other cathode reaction product(s) which are both shock-sensitive. The pyrophoric charged anodes of lithium-sulfur dioxide batteries are covered with smooth crystalline platelets, but partially discharged anodes are covered with a rough, non-adherent layer of lithium dithionite. The explosions which may occur during charging are attributed to thermal runaway reactions of lithium and sulfur dioxide to form lithium dithionite, LiOSO.SO.OLi.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1317] **PEER REVIEWED**Interaction /between trifluoromethyl hypofluorite and lithium/ set in at about 170 deg C with a sufficient exotherm to melt the glass container.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 127] **PEER REVIEWED**… Prolonged contact with steam forms a thermally insulating layer which promotes overheating of the metal and may lead to a subsequent explosion as the insulating layer breaks up.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1318] **PEER REVIEWED**Gallium … undergoes violent reaction on contact with … lithium …[Bingham, E.; Cohrssen, B.; Powell, C.H.; Patty's Toxicology Volumes 1-9 5th ed. John Wiley & Sons. New York, N.Y. (2001)., p. 2:419] **PEER REVIEWED**Phosphorus reacts vigorously below 250 deg C with … lithium …[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-147] **PEER REVIEWED**
Other Hazardous Reaction:
    A highly luminous reaction occurs at room temp, between iodine and lithium …[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-102] **PEER REVIEWED**Molten lithium attacks plastics and rubber.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**Molten lithium at 180 deg C attacks vanadium, beryllium, or chromium severely.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-108] **PEER REVIEWED**Molten lithium attacks carbides and silicates.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-108] **PEER REVIEWED**Molten lithium attacks the following alloys: cobalt alloys, iron alloys, manganese alloys, nickel alloys.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**When nitryl fluoride is passed … over /lithium warmed to 200 to 300 deg C/ glowing or white incandescence occurs.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1094] **PEER REVIEWED**… Lithium rapidly attacked silica or glass at 250 deg C.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1316] **PEER REVIEWED**Passage of the /ethylene/ gas over heated lithium causes latter to incandesce, producing a mixture of lithium hydride and lithium acetylide.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1314] **PEER REVIEWED**An Accelerating rate calorimetry (ARC) study of the thermal and pressure behavior of actual electric batteries under various atypical conditions showed the major contributions to the exothermic behavior as the reactions between lithium and acetonitrile, lithium and sulfur and the decomp of lithium dithionite. The first reaction can generate enough heat to trigger other exothermic reactions …[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1313] **PEER REVIEWED**The reaction of lithium and tantalum pentoxide occurs around 410 deg C with consequent temp rise to 595 deg C.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 491-109] **PEER REVIEWED**
Protective Equipment & Clothing:
    Rubber or plastic gloves; face shield; fire-retardant clothing[U.S. Coast Guard, Department of Transportation. CHRIS - Hazardous Chemical Data. Manual Two. Washington, DC: U.S. Government Printing Office, Oct., 1978.] **PEER REVIEWED**Wear special protective clothing and positive pressure self-contained breathing apparatus.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**Personnel protection: Wear appropriate chemical protective gloves, boots and goggles[Association of American Railroads; Bureau of Explosives. Emergency Handling of Hazardous Materials in Surface Transportation. Association of American Railroads, Pueblo, CO. 2005, p. 535] **PEER REVIEWED**
Preventive Measures:
    SRP: The scientific literature for the use of contact lenses in industry is conflicting. The benefit or detrimental effects of wearing contact lenses depend not only upon the substance, but also on factors including the form of the substance, characteristics and duration of the exposure, the uses of other eye protection equipment, and the hygiene of the lenses. However, there may be individual substances whose irritating or corrosive properties are such that the wearing of contact lenses would be harmful to the eye. In those specific cases, contact lenses should not be worn. In any event, the usual eye protection equipment should be worn even when contact lenses are in place.**PEER REVIEWED**If material not on fire and not involved in fire: Do not use water. Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and sewers. Keep material dry.[Association of American Railroads; Bureau of Explosives. Emergency Handling of Hazardous Materials in Surface Transportation. Association of American Railroads, Pueblo, CO. 2005, p. 535] **PEER REVIEWED**Personnel protection: Avoid breathing dusts, and fumes from burning material. … Do not handle broken packages unless wearing appropriate personal protective equipment. Wash away any material which may have contacted the body with copious amounts of water or soap and water.[Association of American Railroads; Bureau of Explosives. Emergency Handling of Hazardous Materials in Surface Transportation. Association of American Railroads, Pueblo, CO. 2005, p. 535] **PEER REVIEWED**… Hexane is recommended as a suitable washing solvent.[Bretherick, L. Handbook of Reactive Chemical Hazards. 4th ed. Boston, MA: Butterworth-Heinemann Ltd., 1990, p. 1315] **PEER REVIEWED**
Stability/Shelf Life:
    Decomposes in water[Weast, R.C. (ed.). Handbook of Chemistry and Physics. 64th ed. Boca Raton, Florida: CRC Press Inc., 1983-84., p. B-105] **PEER REVIEWED**
Shipment Methods and Regulations:
    No person may /transport,/ offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance … and the hazardous material is properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by … /the hazardous materials regulations (49 CFR 171-177)./[49 CFR 171.2; U.S. National Archives and Records Administration's Electronic Code of Federal Regulations. Available from, as of February 15, 2006: http://www.ecfr.gov] **PEER REVIEWED**The International Air Transport Association (IATA) Dangerous Goods Regulations are published by the IATA Dangerous Goods Board pursuant to IATA Resolutions 618 and 619 and constitute a manual of industry carrier regulations to be followed by all IATA Member airlines when transporting hazardous materials.[International Air Transport Association. Dangerous Goods Regulations. 47th Edition. Montreal, Quebec Canada. 2006., p. 211] **PEER REVIEWED**The International Maritime Dangerous Goods Code lays down basic principles for transporting hazardous chemicals. Detailed recommendations for individual substances and a number of recommendations for good practice are included in the classes dealing with such substances. A general index of technical names has also been compiled. This index should always be consulted when attempting to locate the appropriate procedures to be used when shipping any substance or article.[International Maritime Organization. International Maritime Dangerous Goods Code. London, UK. 2004., p. 64] **PEER REVIEWED**No person may /transport,/ offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance … and the hazardous material is properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by … /the hazardous materials regulations (49 CFR 171-177)./[49 CFR 171.2 (USDOT); U.S. National Archives and Records Administration's Electronic Code of Federal Regulations. Available from, as of December 9, 2015: http://www.ecfr.gov] **QC REVIEWED**The International Air Transport Association (IATA) Dangerous Goods Regulations are published by the IATA Dangerous Goods Board pursuant to IATA Resolutions 618 and 619 and constitute a manual of industry carrier regulations to be followed by all IATA Member airlines when transporting hazardous materials. Lithium is included on the dangerous goods list.[International Air Transport Association. Dangerous Goods Regulations. 55th Edition. Montreal, Quebec Canada. 2014., p. 262] **QC REVIEWED**The International Maritime Dangerous Goods Code lays down basic principles for transporting hazardous chemicals. Detailed recommendations for individual substances and a number of recommendations for good practice are included in the classes dealing with such substances. A general index of technical names has also been compiled. This index should always be consulted when attempting to locate the appropriate procedures to be used when shipping any substance or article. Lithium is included on the dangerous goods list.[International Maritime Organization. IMDG Code. International Maritime Dangerous Goods Code Volume 2 2012, p. 66] **QC REVIEWED**
Storage Conditions:
    Store in a cool, dry, well-ventilated location. Separate from water.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-92] **PEER REVIEWED**Keep under mineral oil or other liquid free from oxygen or water.[The Merck Index. 10th ed. Rahway, New Jersey: Merck Co., Inc., 1983., p. 792] **PEER REVIEWED**
Cleanup Methods:
    Eliminate all ignition sources. Keep water away from release. Shovel into suitable dry container.[Fire Protection Guide to Hazardous Materials. 13 ed. Quincy, MA: National Fire Protection Association, 2002., p. 49-91] **PEER REVIEWED**Spillage Disposal: Wear eye protection, laboratory coat and nitrile rubber gloves. Cover spill with a 1:1:1 mixture by weight of sodium carbonate or calcium carbonate, clay cat litter (bentonite) and sand. Scoop the mixture into a pail and transport to the fume hood. Slowly and with stirring add to a large quantity of 95% ethanol. Mix and let stand for 24 hours. The solid residue may be treated as normal refuse.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 204] **PEER REVIEWED**
Disposal Methods:
    Waste Disposal: Package Lots. Place in a separate labeled container for recycling or disposal by burning. Burn in an open furnace. Use caution and limit to 100 g packages. Small Quantities. Wear eye protection, laboratory coat and nitrile rubber gloves. Work in the fume hood. Equip a 3-necked round-bottom flask with a stirrer, dropping funnel, condenser and heating mantle. Flush the flask with nitrogen and place the lithium (cut in small pieces) in it. Add 30 mL of 95% ethanol per gram of lithium at a rate that causes rapid refluxing. Stirring is started as soon as enough ethanol has been added to make it feasible. The mixture is stirred and heated under reflux until the lithium is dissolved. The heat is turned off, and an equal volume of water is added at a rate that causes no more than mild refluxing. The solution is then cooled, neutralized with 6 M hydrochloric acid (cautiously add a volume of concentrated acid to an equal volume of cold water) and washed down the drain with at least 50 times its volume of water.[Armour, M.A. Hazardous Laboratory Chemicals Disposal Guide. Boca Raton, FL: CRC Press Inc., 1991., p. 204] **PEER REVIEWED**SRP: The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational exposure or environmental contamination. Recycle any unused portion of the material for its approved use or return it to the manufacturer or supplier. Ultimate disposal of the chemical must consider: the material’s impact on air quality; potential migration in soil or water; effects on animal, aquatic, and plant life; and conformance with environmental and public health regulations.**PEER REVIEWED**
Manufacturing/Use Information:

View products that contain this chemical: LITHIUM, ELEMENTAL
Uses:
    As “getter” in vacuum tubes; manufacture of catalysts for polyolefin plastics; in fuels for aircraft, missiles.[The Merck Index. 10th ed. Rahway, New Jersey: Merck Co., Inc., 1983., p. 792] **PEER REVIEWED**In metallurgy, as degasifier, deoxidizer, desulfurizer; as grain refiner in non-ferrous metals.[International Labour Office. Encyclopedia of Occupational Health and Safety. Vols. I&II. Geneva, Switzerland: International Labour Office, 1983., p. 1344] **PEER REVIEWED**Chem intermediate for butyllithium polymerization catalyst; in alloys with aluminum or magnesium for aerospace uses[SRI] **PEER REVIEWED**Catalyst in mfr of synthetic rubber & multipurpose lubricants[Venugopal, B. and T.D. Luckey. Metal Toxicity in Mammals, 2. New York: Plenum Press, 1978., p. 3] **PEER REVIEWED**Aluminum-lithium alloys; ethynylation reagent[Ashford, R.D. Ashford's Dictionary of Industrial Chemicals. London, England: Wavelength Publications Ltd., 1994., p. 541] **PEER REVIEWED**Used as a chemical intermediate for the synthesis of n-butyllithium, lithium hydroxide[Ashford, R.D. Ashford's Dictionary of Industrial Chemicals. London, England: Wavelength Publications Ltd., 1994., p. 541] **PEER REVIEWED**Production of tritium, reducing and hydrogenating agents, alloy hardeners, pharmaceuticals, Grignard reagents. Scavenger and degassifier for stainless and mild steels in molten state, modular iron, soaps and greases, deoxidizer in copper and copper alloys, heat-transfer liquid, storage batteries (with sulfur, selenium, tellurium, and chlorine). Rocket propellants, vitamine A synthesis, silver solders, underwater bouyancy devices, nuclear reactor coolent.[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 674] **PEER REVIEWED**Rechargeable /lithium/ batteries.[Kirk-Othmer Encyclopedia of Chemical Technology. 4th ed. Volumes 1: New York, NY. John Wiley and Sons, 1991-Present., p. V3 1108 (1992)] **PEER REVIEWED**The largest use of lithium metal is in the production of organometallic alkyl and aryl lithium compounds by reaction of lithium dispersions with the corresponding organohalides.[Kirk-Othmer Encyclopedia of Chemical Technology. 4th ed. Volumes 1: New York, NY. John Wiley and Sons, 1991-Present., p. V15 445] **PEER REVIEWED**Lithium metal is becoming increasingly important as an alloying component; it is also used as a deoxidizing and desulfurizing agent, especially for copper, nickel, and alloy steels.[Ullmann's Encyclopedia of Industrial Chemistry. 6th ed.Vol 1: Federal Republic of Germany: Wiley-VCH Verlag GmbH & Co. 2003 to Present, p. V20 45-46 (2003)] **PEER REVIEWED**In production of organometallic alkyl and aryl lithium compounds; in production of high-strength, low-density aluminium alloys for the aircraft industry; extremely tough, low-density alloys with aluminum and magnesium used for armor plate and aerospace components. In polymerization catalysts for the polyolefin plastics industry; manufacture of high-strength glass and glass-ceramics. As anode in electrochemical cells and batteries; as chemical intermediate in organic syntheses. Lithium stearate as thickener and gelling agent to transform oils into lubricating greases.[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. Whitehouse Station, NJ: Merck and Co., Inc., 2006., p. 957] **PEER REVIEWED**
Manufacturers:
    E.I. du Pont de Nemours and Co., 1007 Market St., Wilmington, DE 19898, (302) 774-1000; DuPont Coatings & Color Technologies, DuPont Performance Coatings; Production site: Niagara Falls, NY 14302[SRI Consulting. 2006 Directory of Chemical Producers-United States. Menlo Park, CA. 2006, p. 705] **PEER REVIEWED**
Methods of Manufacturing:
    Recovery of the ore, spodumene, followed by concentration by froth flotation, conversion to lithium chloride, and electrolysis from an anhydrous lithium chloride-potassium chloride mixture.[SRI] **PEER REVIEWED**…High-temperature extraction from spodumene by sodium carbonate; solar evaporation of lake brines.[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**Recovered from natural brines; electrochemical processes; reduction of the oxide with magnesium or aluminum; Hanson, U.S. patent 2,028,390 (1936)[O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. Whitehouse Station, NJ: Merck and Co., Inc., 2006., p. 957] **PEER REVIEWED**Lithium metal is produced only by the electrolysis of molten lithium chloride.[Ullmann's Encyclopedia of Industrial Chemistry. 6th ed.Vol 1: Federal Republic of Germany: Wiley-VCH Verlag GmbH & Co. 2003 to Present, p. V20 44 (2003)] **PEER REVIEWED**Dry Lithium chloride is the feed material for manufacture of Li metal by electrolysis. The cell bath is actually a molten mixture of Li chloride and potassium chloride. The cell is operated at 400 to 420 deg C with a voltage across the cell of 8 to 9 volts. Current consumption in electrolysis is about 18 kw/hr/lb of Li produced.[Clayton, G. D. and F. E. Clayton (eds.). Patty's Industrial Hygiene and Toxicology: Volume 2A, 2B, 2C: Toxicology. 3rd ed. New York: John Wiley Sons, 1981-1982., p. 1729] **PEER REVIEWED**
General Manufacturing Information:
    Available as ingots, rods, wire, ribbon, & pellets.[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**
Formulations/Preparations:
    Grade: 99.86% to 99.9999%[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**
Impurities:
    The purity of the meatal is 99.8% or better with the metallic impurities less than 0.1%[Kirk-Othmer Encyclopedia of Chemical Technology. 3rd ed., Volumes 1-26. New York, NY: John Wiley and Sons, 1978-1984., p. V14 456] **PEER REVIEWED**Purity of metal is 99.8%[Kirk-Othmer Encyclopedia of Chemical Technology. 3rd ed., Volumes 1-26. New York, NY: John Wiley and Sons, 1978-1984., p. V14 456] **PEER REVIEWED**
U. S. Production:
    (1972) LESS THAN 5.6X10+8 GRAMS (USE)[SRI] **PEER REVIEWED**(1975) 4.03X10+9 G (DELIVERIES)[SRI] **PEER REVIEWED**
U. S. Imports:
    770 metric tons /compounds, concentrate, ores, and metal/[Bureau of Mines. Minerals Yearbook. 1992. Washington, DC: U.S. Government Printing Office, 1992., p. 758] **PEER REVIEWED**
U. S. Exports:
    (1975) 2.72X10+7 GRAMS[SRI] **PEER REVIEWED**(1985) 2.36X10+9 g[BUREAU OF MINES. MINERAL COMMODITY SUMMARIES 1986 p.92] **PEER REVIEWED**
Synonyms and Identifiers:

Related HSDB Records:
    6900 [Lithium Compounds]
Synonyms:
    LITHIUM**PEER REVIEWED**LITHIUM, METALLIC**PEER REVIEWED**
Formulations/Preparations:
    Grade: 99.86% to 99.9999%[Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 14th Edition. John Wiley & Sons, Inc. New York, NY 2001., p. 673] **PEER REVIEWED**
Shipping Name/ Number DOT/UN/NA/IMO:
    UN 1415; LithiumIMO 4.3; Lithium
Administrative Information:

Hazardous Substances Databank Number:
    647
Last Review Date:
    Reviewed by SRP on 5/14/2007
Last Revision Date:
    20071011
Update History:
Field Update on 2015-12-21, 9 fields added/edited/deleted
Field Update on 2014-12-05, 2 fields added/edited/deleted
Field Update on 2013-09-20, 1 fields added/edited/deleted
Complete Update on 2007-10-11, 40 fields added/edited/deleted
Field Update on 2007-06-07, 1 fields added/edited/deleted
Field Update on 2006-04-18, 2 fields added/edited/deleted
Field Update on 2006-04-17, 2 fields added/edited/deleted
Complete Update on 02/14/2003, 1 field added/edited/deleted.
Complete Update on 01/24/2003, 1 field added/edited/deleted.
Complete Update on 05/13/2002, 1 field added/edited/deleted.
Complete Update on 02/13/2002, 1 field added/edited/deleted.
Complete Update on 01/18/2002, 9 fields added/edited/deleted.
Field Update on 01/14/2002, 1 field added/edited/deleted.
Complete Update on 08/09/2001, 1 field added/edited/deleted.
Complete Update on 05/16/2001, 1 field added/edited/deleted.
Complete Update on 05/15/2001, 1 field added/edited/deleted.
Complete Update on 06/12/2000, 1 field added/edited/deleted.
Complete Update on 03/28/2000, 1 field added/edited/deleted.
Complete Update on 02/08/2000, 1 field added/edited/deleted.
Complete Update on 02/02/2000, 1 field added/edited/deleted.
Complete Update on 11/18/1999, 1 field added/edited/deleted.
Complete Update on 09/21/1999, 1 field added/edited/deleted.
Complete Update on 08/26/1999, 1 field added/edited/deleted.
Complete Update on 06/02/1998, 1 field added/edited/deleted.
Complete Update on 02/27/1998, 1 field added/edited/deleted.
Complete Update on 01/26/1998, 71 fields added/edited/deleted.
Field Update on 10/17/1997, 1 field added/edited/deleted.
Field Update on 01/24/1997, 1 field added/edited/deleted.
Field Update on 10/12/1996, 1 field added/edited/deleted.
Complete Update on 05/10/1996, 1 field added/edited/deleted.
Complete Update on 03/21/1996, 1 field added/edited/deleted.
Complete Update on 01/19/1996, 1 field added/edited/deleted.
Complete Update on 11/10/1995, 1 field added/edited/deleted.
Complete Update on 12/21/1994, 1 field added/edited/deleted.
Complete Update on 08/18/1994, 1 field added/edited/deleted.
Complete Update on 06/16/1994, 1 field added/edited/deleted.
Complete Update on 03/25/1994, 1 field added/edited/deleted.
Complete Update on 09/14/1993, 1 field added/edited/deleted.
Field update on 12/14/1992, 1 field added/edited/deleted.
Field update on 03/06/1990, 1 field added/edited/deleted.
Complete Update on 09/14/1989, 2 fields added/edited/deleted.
Complete Update on 04/13/1989, 1 field added/edited/deleted.
Complete Update on 10/14/1986
Created 19830401 by GCF

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