Is Capillary Electrophoresis a New Tool to Monitor Acute Lithium Poisoning in Human?†

Abstract

A 38-year-old man was admitted in the intensive care unit (ICU) after supposed ingestion of 504 sustained-release tablets of Theralithe™ corresponding ~200 g of lithium carbonate. At the admission, ~19.5 h after ingestion, the patient was conscious with trembling limbs, intense thirst, profuse sweats and vomiting and lithium serum concentration was 14.2 mmol/L. Toxicological screenings performed in urine and serum, were negative. Patient was treated with continuous extrarenal epuration by continue veno-venous hemodiafiltration starting (CCVHDF) 24 h post-admission and was carried on until 64 h. After 11 days in ICU, the patient was dismissed to the service without sequelae, and transferred to a psychiatric unit. To follow lithium concentrations in serum, urines and dialysates, we developed a simple, rapid and reliable method by capillary zone electrophoresis (CZE). Separation was achieved in 7 min. The method was linear between 0.14 and 1.44 mmol/L for serum samples, and between 0.07 and to 1.44 mmol/L for urines and dialysates. Limits of quantification were 0.15 mmol/L and 0.07 mmol/L for serum and others fluids, respectively. Intra- and inter-day precisions expressed as CV were systematically inferior to 12.1% for serum and 8.2% for other fluids. Results obtained regarding precision, accuracy, recovery and stability were satisfying, with recoveries ranging from 91.0 to 102.0%. Serum, urine and dialysate samples were measured using CZE and flame photometry. We observed a strong correlation between both methods as assessed by linear regression and Bland–Altman analysis. For the intoxicated patient, the assay was successfully applied to serum, urine and dialysates to determine the amount of lithium present in circulation and excreted. Lithium amounts in dialysates were estimated to correspond to 89% of total lithium excreted during CCVHF session while urine excretion account only for 11%.

Advances in Therapeutic Monitoring of Lithium in the Management of Bipolar Disorder

“…Altogether, ISF is an accessible and more reproducible matrix compared to the other biological fluids; hence, it seems to be the most suitable human body fluid for minimally invasive and continuous monitoring of analytes. Lastly, several reports have assessed lithium in urine, as approximately 90% of lithium is eliminated by the renal route [ 35 , 36 , 37 ]. The studies have utilized colorimetric [ 35 ] or capillary electrophoresis [ 36 ] techniques, both of which suffer from some limitations, including unsatisfactory accuracy, the need for pretreatment, and wide variations between patients.…”

“…Lastly, several reports have assessed lithium in urine, as approximately 90% of lithium is eliminated by the renal route [ 35 , 36 , 37 ]. The studies have utilized colorimetric [ 35 ] or capillary electrophoresis [ 36 ] techniques, both of which suffer from some limitations, including unsatisfactory accuracy, the need for pretreatment, and wide variations between patients.…”

“…Capillary electrophoresis, an analytical technique specially adapted for the separation of ions, offers great potential for separation and quantification of lithium and other ions in biological fluids ( Table 3 ) [ 36 ]. Capillary electrophoresis is suggested to allow simultaneous measurement of multiple ions with minimal interference and without the need for selective electrodes [ 42 ].…”

“…While the developed device has been tested in several psychiatric wards and clinical laboratories, it requires further improvements for accurate and precise measurement of small concentrations. More recently, Jamal et al utilized capillary zone electrophoresis for monitoring lithium concentrations in serum, urines (biological fluids), and dialysates (non-biological fluid) of a patient hospitalized with acute lithium poisoning [ 36 ]. The study showed a strong correlation between the results from capillary zone electrophoresis (CZE) and flame photometry measurements.…”

“…The study showed a strong correlation between the results from capillary zone electrophoresis (CZE) and flame photometry measurements. Herein, CZE was suggested to provide the quantification of lithium in the therapeutic concentration range as well as in the context of acute intoxication for different types of biological fluids [ 36 ]. However, the method demonstrated limits of quantification of 0.15 mmol/L and 0.07 mmol/L for serum and other fluids, respectively [ 36 ].…”