Lithium intoxication: Incidence, clinical course and renal function – a population-based retrospective cohort study

Abstract

When prescribing lithium, the risk of toxicity remains a concern. In this study, we examined a cohort of patients exposed to lithium between 1997 and 2013. The aims of this study were to determine the frequency of lithium intoxication and to evaluate the clinical course and changes in renal function. Of 1340 patients, 96 had experienced at least one episode of lithium levels ⩾1.5 mmol/L, yielding an incidence of 0.01 per patient-year. Seventy-seven patients available for review had experienced 91 episodes, of whom 34% required intensive care and 13% were treated with haemodialysis. There were no fatalities. Acute kidney injury occurred, but renal function at baseline was not different to renal function after the episode. Renal impairment was often associated with co-morbidities and other factors. Both intermittent and continuous-venovenous haemodialysis were used, but the clearance of continuous-venovenous haemodialysis can be too low in cases where large amounts of lithium have been ingested. Saline and forced diuresis have been used and are safe. Lithium intoxication seems rare and can be safely managed in most cases. Physicians should not withhold lithium for fear of intoxication in patients who benefit from it. Yet, physicians should have a low threshold to screen for toxicity.

Lithium side effects and toxicity: prevalence and management strategies

“…With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge (Bauer and Gitlin 2016). Etiologies of lithium intoxication include intentional or accidental overdose, and any factor that alters salt and/or water balance such as the initiation of new medications that alters lithium excretion, dehydration, and infections with fever (Hansen and Amdisen 1978; Haussmann et al 2015; Ott et al 2016). Given the potential consequences of lithium toxicity, particular care and vigilant monitoring should be core treatment components with older patients given lithium, since they are more vulnerable to lithium intoxication and at far lower levels than younger patients.…”

Accidental chronic lithium toxicity

“…5 Concomitant medications to avoid include tricyclic antidepressants, those that decrease the glomerular filtration rate, nonsteroidal anti-inflammatory drugs, renin-angiotensin converting-enzyme inhibitors and diuretics. 8 Intensive care unit admission with intubation may also be required during times that clinically suggest an impending central nervous system failure such as impaired consciousness, seizures and coma. 14…”

Current Status on Pulsed Laser Deposition of Coatings from Animal-Origin Calcium Phosphate Sources

“…Despite its proven efficacy [159], there are reports when lithium administration determined side effects such as thirst and excessive urination, nausea, diarrhea, tremor, weight gain, sexual dysfunction, dermatological effects, and long-term effects on the thyroid gland, kidneys, and parathyroid glands [160]. However, recent studies challenge this negative perception of lithium administration, stating that intoxication occurs only when the concentration is higher than 1.5 mmol/L, and its main adverse effects can be properly monitored and managed [11,[161][162][163].…”