Analyse zu Risikofaktoren, Ätiologie und Behandlungsstandard der Lithiumintoxikation

Haußmann, Robert; Mudra, Tobias Niels; Sauer, Cathrin; Bonin, Simone von; Donix, Markus; Bauer, Michael; Lewitzka, Ute

doi:10.1007/s00115-019-0705-7

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…Chronic lithium intoxication was the most prevalent type of intoxication (66.9%), followed by acute-on-chronic and acute intoxications. This is in accordance with a large body of literature (Buckley et al, 2020; Haussmann et al, 2020; Krenova and Pelclova, 2006; Ott et al, 2016).…”

Section: Discussionsupporting

confidence: 93%

“…About 40% of patients received at least one risk medication (including thiazide and loop diuretics, ACE inhibitors, ARBs, or NSAIDs). This is very close to the corresponding proportions reported by Haussmann and colleagues (38.2% ACE inhibitors, 29.6% NSAIDs, and 25.9% diuretics) (Haussmann et al, 2020) as well as in other studies (Juurlink et al, 2004). Physicians should be aware of this risk and consider substitutes when prescribing potentially interacting medication.…”

Section: Discussionsupporting

confidence: 91%

“…We collected a variety of clinical and laboratory data from the identified cases, using both paper and electronic medical records. The selection of variables was based on previous research (Haussmann et al, 2020; McKnight et al, 2012; Okusa and Crystal 1994; Ott et al, 2016; Timmer and Sands 1999). All data were extracted from the patient’s hospital records and had previously been obtained in routine medical care.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, lithium intoxications are commonly categorized into three distinct types of intoxication: acute intoxications occur in patients who are lithium naïve and/or are starting lithium treatment by increasing the lithium dose; acute-on-chronic intoxications occur after dose increases while on a steady lithium treatment (e.g., to increase the serum concentration); finally, chronic intoxications occur if the ingested lithium dose remains stable but surrounding factors change (e.g., the addition of other drugs compromising the lithium clearance like thiazide diuretics or concomitant infections) (Baird-Gunning et al, 2017;Haussmann et al, 2015Haussmann et al, , 2020Oakley et al, 2001;Waring et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records

Kaczmarczyk,

Batke,

Wingenfeld

et al. 2023

J Psychopharmacol

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Background: The mood stabilizer lithium has a narrow therapeutic index with a relevant risk of intoxication. We used real-world hospital data to identify causes, treatment courses, and outcomes of high lithium levels and intoxications. Methods: Retrospective chart review of patients with a lithium concentration of ⩾1.1 mmol/L, who were treated at Charité University Medical Center Berlin. Results: We identified 136 patients (58% women; mean age: 54.7 years) with high lithium levels or intoxication. 66.9% were chronic (stable lithium dose but changes in other variables such as co-medication). 40.4% took at least one risk medication with a relative contraindication for concurrent lithium treatment. 11.1% of the cases with a high therapeutic level showed moderate to severe intoxications. Feverish infections were significantly associated with severe intoxications. Overall, 97.1% (132/136) of patients fully recovered, two had residual but mild symptoms and two died during hospitalization (unlikely related to the intoxication). In 37.5% of patients, no psychiatrist was involved in the management of high lithium levels or intoxication. In these patients, lithium treatment was adjusted or discontinued in 37.3% of the cases compared to 64.7% when a psychiatrist was involved (χ²(1) = 9.683, p = 0.002). Conclusions: Patients and medical doctors should be aware of the increased risk of lithium intoxication already within the high therapeutic range and should consider alternative medications without relative contraindications for concurrent lithium use. Involving psychiatrists during or after an intoxication event is associated with more frequent adjustment of the maintenance lithium dose and should be considered in most cases.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records

Kaczmarczyk,

Batke,

Wingenfeld

et al. 2023

J Psychopharmacol

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“…1). In einer retrospektiven monozentrischen Kohortenstudie traten 35 % aller Lithiumintoxikationen während einer stationären Behandlung auf, was ausschließlich durch unzureichendes Wissen der Behandler über die Lithiumtherapie erklärbar ist und auf Arzneimittelinteraktionen zurückzuführen war [17].…”

Section: Metabolisch-basierte Interaktionenunclassified

Interaktionen von Psychopharmaka

Petri

2020

Klinikarzt

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ZUSAMMENFASSUNGPatienten mit seelischen Erkrankungen nehmen häufig Psychopharmaka ein, die Interaktionsrisiken bergen. Auch bei einer gewöhnlich kurzen stationären Verweildauer können in der Kombinationstherapie Wechselwirkungen zu seltenen, aber vital bedrohlichen Nebenwirkungen führen. Deshalb sollten dem klinisch tätigen Arzt die hierauf beruhenden Wirkmechanismen bekannt sein. Bei Verschreibung neuer Medikamente sind diese mit den bereits bestehenden Verordnungen von Psychopharmaka auf mögliche Arzneimittelinteraktionen zu überprüfen. Durch Wechselwirkungen verursachte unerwünschte Arzneimittelwirkungen sind in der Regel vorhersagbar und damit potenziell vermeidbar. Lässt sich eine risikobehaftete Kombinationstherapie nicht vermeiden, sollte auf entsprechende Frühsymptome geachtet werden und bekannte Risikofaktoren minimiert werden. Im Vordergrund steht aber das Erkennen und Vermeiden problematischer Medikationen. Computergestützte Programme können hierbei eine hilfreiche Unterstützung leisten, jedoch sollten dem Patienten keine zweckmäßigen Arzneimitteltherapien vorenthalten werden aufgrund einer Overalertness.

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Anti-suicidal Properties of Lithium Treatment

Lewitzka

2021

Suicide Risk Assessment and Prevention

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Analyse zu Risikofaktoren, Ätiologie und Behandlungsstandard der Lithiumintoxikation

Cited by 7 publications

References 14 publications

Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records

Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records

Interaktionen von Psychopharmaka

Anti-suicidal Properties of Lithium Treatment

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