Lithium carbonate is a common treatment for mood disorders, but it has a very narrow therapeutic index and can be toxic to multiple organ systems. Unfortunately, many patients suffer toxic effects through the course of their therapy. We describe a patient with toxic effects from a high dose of lithium who was successfully treated with normal saline diuresis. We discuss the properties that make lithium susceptible to normal saline diuresis and explore alternative options for treatment of lithium toxicity.