Extracorporeal Treatment for Lithium Poisoning

Decker, Brian S.; Goldfarb, David S.; Dargan, Paul I.; Friesen, Marjorie; Gosselin, Sophie; Hoffman, Robert S.; Lavergne, Valéry; Nolin, Thomas D.; Ghannoum, Marc

doi:10.2215/cjn.10021014

Cited by 136 publications

(148 citation statements)

References 150 publications

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“…In the most severe cases, defined by extraordinarily high lithium levels (>4.0 mmol/l) or marked clinical symptoms, especially altered consciousness, extracorporeal methods such as hemodialysis should be instituted. If hemodialysis is required, it is usually done repeatedly to avoid lithium rebound caused by a redistribution of lithium from deeper compartments or red blood cells to the plasma (Decker et al 2015). More detailed treatment recommendations can be found elsewhere (Decker et al 2015; Haussmann et al 2015; Baird-Gunning et al 2016).…”

Section: Resultsmentioning

confidence: 99%

Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

346

301

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Despite its virtually universal acceptance as the gold standard in treating bipolar disorder, prescription rates for lithium have been decreasing recently. Although this observation is multifactorial, one obvious potential contributor is the side effect and toxicity burden associated with lithium. Additionally, side effect concerns assuredly play some role in lithium nonadherence. This paper summarizes the knowledge base on side effects and toxicity and suggests optimal management of these problems. Thirst and excessive urination, nausea and diarrhea and tremor are rather common side effects that are typically no more than annoying even though they are rather prevalent. A simple set of management strategies that involve the timing of the lithium dose, minimizing lithium levels within the therapeutic range and, in some situations, the prescription of side effect antidotes will minimize the side effect burden for patients. In contrast, weight gain and cognitive impairment from lithium tend to be more distressing to patients, more difficult to manage and more likely to be associated with lithium nonadherence. Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild. A small but measurable percentage of lithium-treated patients will show progressive renal impairment. Infrequently, lithium will need to be discontinued because of the progressive renal insufficiency. Lithium-induced hypothyroidism is relatively common but easily diagnosed and treated. Hyperparathyroidism from lithium is a relatively more recently recognized phenomenon.

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Section: Resultsmentioning

confidence: 99%

Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

346

301

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“…Lithium rebound is an increase in lithium serum levels, and potentially recurrence of toxicity symptoms, after the cessation of extracorporeal treatment 10. Typically, this occurs over the following 6–12 hours, although it may take longer in the situation of delayed absorption preparations or decreased gastrointestinal mobility 10…”

Section: Discussionmentioning

confidence: 99%

“…The USA Extracorporeal Treatments in Poisoning (EXTIP) workgroup published recommendations on the use of renal replacement therapy for poisoning in 2015 10. The EXTIP workgroup reviewed 166 articles (mostly case reports totalling 418 patients), of which they could extract patient-level data in 228.…”

Section: Discussionmentioning

confidence: 99%

Lithium overdose and delayed severe neurotoxicity: timing for renal replacement therapy and restarting of lithium

et al. 2017

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This is a case report of a man in his 60s who presented to an English hospital following a significant lithium overdose. He was monitored for 24 hours, and then renal replacement therapy was initiated after assessment by the renal team. As soon as the lithium level returned to normal therapeutic levels (from 4.7 mEq/L to 0.67 mEq/L), lithium was restarted by the medical team. At this point, the patient developed new slurred speech and later catatonia. In this case report, we discuss the factors that could determine which patients are at risk of neurotoxicity following lithium overdose and the appropriate decision regarding when and how to consider initiation of renal replacement therapy and restarting of lithium.

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“…In an effort to improve the quality of data going into their evaluations, the EXTRIP workgroup recommended greater standardization of case reports to include details about the patient, the poison, the presentation, treatments other than extracorporeal therapy, type of extracorporeal therapy, poison sampling, toxicokinetic calculations, followup, time-line of significant events, discussion and conclusion [84]. So far, the workgroup has issued recommendations on extracorporeal treatment for poisoning from thallium [85], tricyclic antidepressants [86], barbiturates [87], acetaminophen [88], carbamazepine [89], methanol [90], lithium [91], theophylline [48] and salicylates [92].…”

Section: Extripmentioning

confidence: 99%