Acute Lithium Intoxication and Neuroleptic Malignant Syndrome

Gill, J. Brian; Singh, Harmohan; Nugent, Kenneth

doi:10.1592/phco.23.6.811.32179

Cited by 60 publications

(28 citation statements)

References 26 publications

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“…Potent neuroleptics, such as haloperidol or fluphenazine, and potentially depot intramuscular preparations cause NMS more frequently, but all antipsychotics including atypical ones may precipitate it [1,15,16,22,63]. Rarely, NMS has been documented after giving metoclopramide [48], amoxapine [68] and lithium [30]. NMS can be triggered by rapid dopamine agonist withdrawal [52].…”

Section: ■ Neuroleptic Malignant Syndromementioning

confidence: 99%

Diagnosis and management of acute movement disorders

Dressler

2005

J Neurol

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Most movement disorders, reflecting degenerative disorders, develop in a slowly progressive fashion. Some movement disorders, however, manifest with an acute onset. We wish to give an overview of the management and therapy of those acute-onset movement disorders.Drug-induced movement disorders are mainly caused by dopamine-receptor blockers (DRB) as used as antipsychotics (neuroleptics) and antiemetics. Acute dystonic reactions usually occur within the first four days of treatment. Typically, cranial pharyngeal and cervical muscles are affected. Anticholinergics produce a prompt relief. Akathisia is characterized by an often exceedingly bothersome feeling of restlessness and the inability to remain still. It is a common side effect of DRB and occurs within few days after their initiation. It subsides when DRB are ceased. Neuroleptic Malignant Syndrome is a rare, but life-threatening adverse reaction to DRB which may occur at any time during DRB application. It is characterised by hyperthermia, rigidity, reduced consciousness and autonomic failure. Therapeutically immediate DRB withdrawal is crucial. Additional dantrolene or bromocriptine application together with symptomatic treatment may be necessary. Paroxysmal dyskinesias are childhood onset disorders characterised by dystonic postures, chorea, athetosis and ballism occurring at irregular intervals. In Paroxysmal Kinesigenic Dyskinesia they are triggered by rapid movements, startle reactions or hyperventilation. They last up to 5 minutes, occur up to 100 times per day and are highly sensitive to anticonvulsants. In Paroxysmal Non-Kinesiogenic Dyskinesia they cannot be triggered, occur less frequently and last longer. Other paroxysmal dyskinesias include hypnogenic paroxysmal dyskinesias, paroxysmal exertional dyskinesia, infantile paroxysmal dystonias, Sandifer's syndrome and symptomatic paroxysmal dyskinesias. In Hereditary Episodic Ataxia Type 1 attacks of ataxia last for up to two minutes, may be accompanied by dysarthria and dystonia and usually respond to phenytoin. In Type 2 they can last for several hours, may be accompanied by vertigo, headache and malaise and usually respond to acetazolamide. Symptomatic episodic ataxias can occur in a number of metabolic disorders, but also in multiple sclerosis and Behcet's disease.

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Section: ■ Neuroleptic Malignant Syndromementioning

confidence: 99%

Diagnosis and management of acute movement disorders

Dressler

2005

J Neurol

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“…Lithium's widespread use and its narrow therapeutic index can lead to adverse effects in up to 90% of all users [7][8][9][10][11]. Most toxicity is mild and includes lethargy, vomiting, ataxia, and myoclonus, but massive, acute ingestions or severe chronic toxicity can lead to coma or seizures.…”

Section: Discussionmentioning

confidence: 99%

“…Most toxicity is mild and includes lethargy, vomiting, ataxia, and myoclonus, but massive, acute ingestions or severe chronic toxicity can lead to coma or seizures. Other adverse effects include thyroid and parathyroid abnormalities, serotonergic crisis, cardiovascular abnormalities, and nephrogenic diabetes insipidus [9,[11][12][13]. Onset and severity of symptoms vary upon the timing of ingestion and product formulation.…”

Section: Discussionmentioning

confidence: 99%

Lithium toxicity from an internet dietary supplement

Pauzé

Brooks

2007

J. Med. Toxicol.

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“…Most (83%) of the reported patients experienced some degree of clinical improvement either during or on cessation of ECTR. There were 14 deaths reported from 228 patients included (23,25,52, 70,74,75,93,96,104,119,139,159,162) (slightly more in those who were acutely poisoned). In these patients, the cause of death was cardiopulmonary failure, sepsis, brain death, or unrelated to lithium.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Extracorporeal Treatment for Lithium Poisoning

Decker¹,

Goldfarb²,

Dargan³

et al. 2015

Clinical Journal of the American Society of Nephrology

150

139

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on behalf of the EXTRIP Workgroup Abstract The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D).

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Acute Lithium Intoxication and Neuroleptic Malignant Syndrome

Cited by 60 publications

References 26 publications

Diagnosis and management of acute movement disorders

Diagnosis and management of acute movement disorders

Lithium toxicity from an internet dietary supplement

Extracorporeal Treatment for Lithium Poisoning

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