Risk Factors for Utilization of Acute Care Services for Lithium Toxicity

Abstract

Newly initiated, potentially interacting medications are a major preventable driver of ACS use for lithium toxicity, whereas age, chronic disease, and total daily lithium dose are small but significant factors. Clinicians should use extra caution when initiating a potentially interacting medication.

Lithium: An underutilized element

“…8 A recently published US analysis found the prevalence rate of lithium toxicity was 2.2%. 9 Results from both groups show that drug interactions were an important cause of increased lithium levels, and specifically that initiating a medication that could interact with lithium was associated with 30-fold higher risk of needing acute care for lithium toxicity. 9 Possible drug interactions include nonsteroidal anti-inflammatory drugs, diuretics, and renin-angiotensin-aldosterone system inhibitors.…”

“…9 Results from both groups show that drug interactions were an important cause of increased lithium levels, and specifically that initiating a medication that could interact with lithium was associated with 30-fold higher risk of needing acute care for lithium toxicity. 9 Possible drug interactions include nonsteroidal anti-inflammatory drugs, diuretics, and renin-angiotensin-aldosterone system inhibitors. 9 Because lithium is eliminated exclusively by the kidneys, impaired or altered renal function can increase the risk of lithium retention, leading to intoxication.…”

“…9 Possible drug interactions include nonsteroidal anti-inflammatory drugs, diuretics, and renin-angiotensin-aldosterone system inhibitors. 9 Because lithium is eliminated exclusively by the kidneys, impaired or altered renal function can increase the risk of lithium retention, leading to intoxication. Other risk factors include older age, alteration of watersalt homeostasis (fever, diarrhea, vomiting), higher number of treated chronic diseases as measured by Chronic Disease Score (range: 0 to 35; higher scores denotes higher…”

“…number of treated chronic diseases and increased hospitalization risk), and higher total daily lithium dosage. 9 Presentation of lithium intoxication often is mild or nonspecific, and physicians should have a low threshold for checking lithium blood levels. 8 Lithium intoxication can be safely managed with volume expansion, forced diuresis, and hemodialysis.…”

Management of lithium intoxication

“…There are few population-based studies reporting on rates of lithium toxicity. A case–control study identified a prevalence rate of 2% for lithium toxicity over a 5-year study period (Heath 2018), whereas a large Swedish population-based study identified a rate of 7% over a 17-year period (Ott 2016). Lithium intoxication is a common occurrence over several years of treatment but annual incidence remains low, with an incidence rate of 1/100 lithium-treated patients developing intoxication per year of lithium treatment in the Swedish observational study (Ott 2016).…”