Is environmental temperature related to renal symptoms, serum lithium levels, and other laboratory test results in current lithium users?

Rej, Soham; AlAqeel, Bandar; Segal, Marilyn; Low, Nancy; Mucsi, István; Holcroft, Christina; Looper, Karl

doi:10.1002/hup.2413

Cited by 5 publications

(4 citation statements)

References 13 publications

(28 reference statements)

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“…It is a drug with a narrow therapeutic index; therefore, careful therapeutic drug monitoring is needed to maximize effectiveness and to minimize ADEs and toxicity. Patients using lithium are known to have a high intra- and interpatient variability in dose—concentration relationship, and external factors including drug–drug interactions, environmental temperature, and fluid and electrolyte intake may influence lithium serum levels (Amdisen 1980 ; Huang et al 2008 ; Wilting et al 2005 ; Wilting et al 2007 ; Rej et al 2014 ). Recommendations regarding optimal lithium serum levels differ among clinical practice guidelines, with the most common range being between 0.6 and 0.8 mmol/L for maintenance treatment (Malhi et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Nederlof

Heerdink

Egberts

et al. 2018

Int J Bipolar Disord

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BackgroundAdequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder.MethodsUsing networks of various professional organizations, an anonymous online survey was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated.ResultsThe survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited.ConclusionsLithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium.Electronic supplementary materialThe online version of this article (10.1186/s40345-018-0120-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Nederlof

Heerdink

Egberts

et al. 2018

Int J Bipolar Disord

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“…Hong Kong's climate is subtropical with high humidity, which the authors postulate facilitates sweating to act as a buffer to offset increased intake of hypotonic fluids in summer. No association was reported between serum sodium and temperature in 63 adults exposed to lithium in Canada 38 …”

Section: Resultsmentioning

confidence: 95%

“…No association was reported between serum sodium and temperature in 63 adults exposed to lithium in Canada. 38…”

Section: Medication-associatedmentioning

confidence: 99%

Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature

Wootton,

Grossmann,

Warren

2024

Clinical Endocrinology

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ObjectiveBoth hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations.DesignSystematic review, reported in accordance with PRISMA guidelines.MethodsMEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included.ResultsOf 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat‐associated dysnatremia. The risk of bias was assessed to be high in all but four studies.ConclusionsHigher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence‐based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.

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“…We examine temperature over 1- and 5-day time frames and also month and season. Previous studies of health effects of temperature have used 1 day (Rej et al, 2014; Wang et al, 2014; Wilting et al, 2007), 3 days (Ye et al, 2012), 5–10 days (Gasparrini and Armstrong, 2010) or even a month (Chang et al, 2004). However, there is no established time frame for higher temperatures to have an impact on health outcomes, generally or for this particular problem.…”

Section: Discussionmentioning

confidence: 99%

Seasonal and temperature effect on serum lithium concentrations

Buckley

Siu

Chiew

et al. 2019

Aust N Z J Psychiatry

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Background: Lithium remains the gold standard treatment for bipolar disorder. However, it has a very narrow therapeutic index (0.6–0.8 mmol/L). It has been suggested that high environmental temperature can lead to dehydration, elevated plasma lithium concentration and then lithium toxicity. Objectives: We aimed to investigate the effect of seasonal and short-term changes in temperature on serum lithium concentrations in Sydney, Australia. Methods: We retrospectively analysed data from all patients who had serum lithium concentrations taken from the Prince of Wales and Sutherland Hospitals between 2008 and 2018. Temperature data came from the Bureau of Meteorology. We examined correlations between lithium concentrations and the preceding 5 days maximum temperatures, month and season. We also performed a longitudinal analysis of the effect of temperature and seasons within selected patients who had repeated levels. Results: A total of 11,912 serum lithium concentrations from 2493 patients were analysed. There was no significant association between higher lithium concentration and preceding higher temperatures ( r = –0.008, p = 0.399). There was also no important seasonal or monthly variation, across all patients or in the smaller cohort with longitudinal data ( n = 123, r = 0.008, 95% confidence interval: [–0.04, 0.06]). Conclusion: There were no clinically important differences in serum lithium concentration related to seasons, months or temperatures, which suggests that patients on lithium are able to adequately maintain hydration during hot weather in Sydney.

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Is environmental temperature related to renal symptoms, serum lithium levels, and other laboratory test results in current lithium users?

Cited by 5 publications

References 13 publications

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature

Seasonal and temperature effect on serum lithium concentrations

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