Comparison of the EXtracorporeal TReatments In Poisoning (EXTRIP) and Paris criteria for neurotoxicity in lithium poisoned patients

Abstract

Aims Two guidelines for haemodialysis in lithium poisoning, one from the Extracorporeal TReatments in Poisoning (EXTRIP) workgroup and a single centre retrospective one (Paris) differ. We compared outcomes in lithium poisoning based on these criteria with a primary outcome of worsening neurological symptoms in patients for whom EXTRIP and Paris criteria were discordant. Methods Poison centre data were queried for lithium poisoned patients for whom haemodialysis was either recommended or performed. Patients were categorized according to EXTRIP and Paris criteria and excluded if the peak lithium concentration was <1.2 mmol/L or if neurological follow‐up was unavailable. Comparative analyses were only performed when both criteria could be assessed. Results In total, 219 patients were analysed. Paris criteria were met in 70 and EXTRIP criteria in 178. Forty two patients were excluded because Paris criteria could not be evaluated. When Paris and EXTRIP both supported haemodialysis, 50/57 (88%) of patients who received haemodialysis improved, as did all 3 who did not receive haemodialysis. When Paris and EXTRIP did not support haemodialysis, all nondialysed patients did well. Among the 86 patients for whom EXTRIP supported haemodialysis but Paris did not, 4/19 (21%) patients not dialysed deteriorated (P = .02; odds ratio = 8.7, 95% confidence interval = 1.5–51.8), 1 of whom died. All 8 patients for whom Paris criteria supported haemodialysis but EXTRIP did not were dialysed and improved. Conclusions When the EXTRIP and Paris criteria are discordant, EXTRIP criteria outperforms the Paris criteria at identifying potentially ill patients who might benefit from haemodialysis.

Biomedical and Potential Therapeutic Aspects of Lithium Carbonate Use

“…Острая интоксикация карбонатом лития развивается при концентрации выше 3,0 ммоль/л. Основными причинами острой интоксикации являются передозировка [19][20][21][22] и гипонатриемия [23], что может быть спровоцировано дегидратацией (из-за острых кишечных инфекций, физических нагрузок, повышенного потоотделения), диетой (ограничение приема соли), применением диуретиков и слабительных.…”

The desperate searching for reliable and convenient criteria of haemodialysis in the lithium‐poisoned patient

“…

We read with interest the study comparing Paris and EXTRIP criteria of haemodialysis in lithium poisoning, recently published in the journal. 1 The authors used a poison centre cohort of lithium-poisoned patients for whom haemodialysis was recommended or performed.Patients were classified according to both Paris and EXTRIP criteria and to whether they were or not dialysed. The endpoint was worsening neurological status or death, if mentioned in the narrative.

…”

“…We read with interest the study comparing Paris and EXTRIP criteria of haemodialysis in lithium poisoning, recently published in the journal. 1 The authors used a poison centre cohort of lithium-poisoned patients for whom haemodialysis was recommended or performed.…”