Identifying lithium‐poisoned patients who may benefit from haemodialysis remains highly challenging

Abstract

Buckley et al. retrospectively assessed the need for haemodialysis based on the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup criteria in a cohort of 361 lithium-poisoned patients. 1 We would like to congratulate the authors for their attempt to improve EXTRIP criteria and discuss their results in the light of our recently published study assessing EXTRIP criteria similarly in a cohort of 128 lithium-poisoned patients. 2 It is noteworthy that we used more

Development and validation of a risk prediction nomogram for disposition of acute clozapine intoxicated patients to intensive care unit

“…The studied xenobiotics were acetaminophen, carbon monoxide, opioids, antidepressants, salicylates, methanol, lithium, pesticides, central nervous system affecting xenobiotics, and other unspecified drug classes. 14,17,18,31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] So, the current study was the first to endorse a new feasible bedside tool, nomogram, to stratify the patients exposed to a high dose of clozapine according to their severity and need for ICU admission. The decision of ICU admission is crucial, particularly in cases of drug poisoning as vital signs of poisoned patients should be continuously monitored.…”

Lithium Poisoning Update in Diagnosis and Treatment

“…The clinical characteristics of the drug, for example, its small molecular weight, low binding to plasma proteins, low volume of distribution, and poor endogenous clearance, make hemodialysis the therapeutic strategy of greatest evidence and use in the context of lithium poisoning [39,40]. The goals of hemodialysis are to decrease high concentrations of lithium in toxic behaviors, such as the central nervous system, and to favor a concentration gradient that allows lithium to diffuse into plasma for its subsequent elimination [41].…”

Translating EXTRIP criteria to better define patients with lithium toxicity for haemodialysis

“…We thank Vodovar et al 1 for their interest, and we agree there are difficulties in deciding the best way to apply Extracorporeal Treatments In Poisoning (EXTRIP) criteria. 2 However, they have performed re-interpretation of our data which uses flawed methods and has reached a conclusion that could potentially mislead clinicians.…”