Lithium Toxicity with Severe Bradycardia Post Sleeve Gastrectomy: a Case Report and Review of the Literature

Dahan, Arik; Porat, Daniel; Azran, Carmil; Mualem, Yoni; Sakran, Nasser; Abu‐Abeid, Subhi

doi:10.1007/s11695-018-3597-x

Cited by 31 publications

(19 citation statements)

References 18 publications

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“…The modified GI anatomy after bariatric surgery may significantly affect the oral absorption of many drugs [10,11]. Although malabsorptive bypass procedures are highly prone to cause such effects, restrictive surgeries, e.g., LSG, may also alter the pharmacokinetics (PK) of various drugs [12,13,14]. Many parameters that dictate the absorption of a drug may be altered after the surgery, e.g., stomach volume and pH, gastric motility and transit time [10,15].…”

Section: Introductionmentioning

confidence: 99%

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial

Porat

Marković

Zur

et al. 2019

JCM

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Oral drug bioavailability may be significantly altered after laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure worldwide. Paracetamol (acetaminophen) is the post-bariatric analgesic/antipyretic drug of choice. In this work we studied and analyzed the LSG effects on systemic bioavailability and pharmacokinetics of paracetamol after oral administration of solid vs. liquid dosage form. A 4-armed, pharmacokinetic, crossover trial was performed in patients enrolled for LSG. Single paracetamol dose (500 mg), as caplet (n = 7) or syrup (n = 5), was administered before vs. 4–6 months post-LSG. Bioavailability was enhanced after LSG; in the caplet groups, average AUC0–t increased from 9.1 to 18.6 µg·h/mL with AUC0–t difference of 9.5 µg·h/mL (95% CI 4.6–14.5, p = 0.003). Cmax increased from 1.8 (95% CI 1.2–2.5) to 4.2 µg/mL (3.6–4.8) after LSG (p = 0.032). In the syrup groups, AUC0–t increased from 13.4 to 25.6 µg·h/mL, with AUC0–t difference of 12.2 µg·h/mL (95% CI 0.9–23.5, p = 0.049). Cmax changed from 5.4 (95% CI 2.5–8.4) to 7.8 µg/mL (6.1–9.6), and systemic bioavailability was complete (102%) after the surgery. Overall, decreased paracetamol exposure in obesity, with recovery to normal drug levels (caplet) or even higher (syrup) post-LSG, was revealed. In conclusion, attention to paracetamol effectiveness/safety in obesity, and after bariatric surgery, is prudent.

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Section: Introductionmentioning

confidence: 99%

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial

Porat

Marković

Zur

et al. 2019

JCM

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“…We found 6 case reports of relevance in the literature. [ 10 – 15 ] Four cases were presented after RYGB surgery and 2 cases after SG (Table 2 ). While several cases of lithium toxicity after RYGB were previously reported, reports after SG were still limited.…”

Section: Discussionmentioning

confidence: 99%

“…Dehydration and acute kidney injury would lead to the decrement of serum lithium clearance and hence lithium intoxication. [ 15 , 18 ] Due to gastric volume reduction after SG, our patient suffered from chronic gastrointestinal symptoms and was unable to intake adequate fluid, which led to a chronic dehydration status. Finally, he also manifested acute, persistent, watery diarrhea, which was a common symptom of lithium toxicity.…”

Section: Discussionmentioning

confidence: 99%

Lithium toxicity with prolonged neurologic sequelae following sleeve gastrectomy

Lin¹,

Liu²,

Wu³

et al. 2020

Medicine

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Rationale: Lithium is the first-line medication for bipolar disorder, given a narrow therapeutic window of 0.8 to 1.2 mEq/L. Change of lithium pharmacokinetics following bariatric surgery may lead to lithium toxicity, which is particularly concerned. Patient concerns: We presented a 39-year-old man with morbid obesity and bipolar affective disorder for 20 years, who was treated with lithium. He developed serious lithium toxicity following sleeve gastrectomy and prolonged neurologic sequelae. Diagnoses: He suffered from persistent watery diarrhea, general weakness, and then drowsy consciousness. Lithium level was checked immediately to be 3.42 mEq/L and lithium toxicity was diagnosed. Interventions: After 3 courses of hemodialysis, his serum lithium level subsequently declined to 0.63 mEq/L, while his consciousness returned normal. Lithium was replaced by lamotrigine. Outcomes: The patient was discharged thirty-five days after admission, while his serum lithium declined to 0.06 mEq/L. Neurologic sequelae were noted by muscle weakness and pain sensation in both feet. The nerve conduction test revealed sensorimotor polyneuropathy with conduction block. He was advised to keep a passive range of motion exercise. Lessons: Although the consensus guideline remains lacking, our report reviewed cases of relevance in the literature and highlighted the awareness of the potential risk of lithium toxicity following bariatric surgery. We suggest close monitoring of the lithium levels and perhaps a dosage adjustment for the postoperative period.

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“…RYGB sonrası efektif barsak uzunluğunun azalması sebebiyle lityum emiliminin azalabileceği ve bu sebeple efektif düzeye ulaşmanın zor olacağı düşünülebilir. Ancak çeşitli olgu raporlarında RYGB veya sleeve gastrektomi sonrasında lityum intoksikasyonu gösterilmiştir (8)(9)(10)(11)(12)(13). Adaptif olarak ortaya çıkan mukozal hipertrofi lityum absorpsiyonunun artmasına yol açmış olabilir.…”

Section: Discussionunclassified

Bariatrik Cerrahi Sonrasında Lityum Düzeyi Etkilenir mi?

Topaloğlu¹

2020

Turkish Journal of Diabetes and Obesity

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Introduction: In patients with medication for chronic illnesses, using medications for chronic illnesses, the doses of drugs should be adjusted before bariatric surgery. Studies investigating the pharmacokinetics of the oral drugs used after bariatric surgery are limited. We will present a young bipolar male obese patient who should continue to use lithium after bariatric surgery.Case: Twenty-six-year-old male was applied to our clinics with the complaint of weight gain of 20 kg in a year. This patient was reported to have taken risperidone 2 mg tb 1x1 and lithium capsule 1x3 due to bipolar disorder (BPD). Also, the patient who had previously been diagnosed with asthma did not take any inhaler medication for it. On physical examination; body weight was 195 kg, height 184 cm, body mass index 57.5 kg/m 2 and vital findings were stable. Respiratory examination revealed rhonchus, and the examination of other organ systems was unremarkable. Laboratory evaluation revealed that glucose was 480 mg/dL, creatinine: 0.

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Lithium Toxicity with Severe Bradycardia Post Sleeve Gastrectomy: a Case Report and Review of the Literature

Cited by 31 publications

References 18 publications

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial

Lithium toxicity with prolonged neurologic sequelae following sleeve gastrectomy

Bariatrik Cerrahi Sonrasında Lityum Düzeyi Etkilenir mi?

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