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Lithium may cause arrhythmias, or irregular heartbeat, throughout the course of therapy. If the patient experiences heart palpitations or uneven heart beat, he should seek medical care right away.
I never saw or heard of any form of liver toxicity, or elevation in blood glucose levels, for those using either Lithium Carbonate or Lithium Citrate. Lithium Orotate usage has not been evaluated sufficiently enough to render an opinion about it possible long term side-effects. What is known about Lithium is that it may affect heart rhythm, adversely affect thyroid functioning, and should be monitored closely in folks with kidney disease (Lithium is processed through the kidneys). In conclusion, recent available clinical data shows Lithium to be safe if taken as directed.