Lithium intoxication and nephrogenic diabetes insipidus: a case report and review of literature

Erden, Abdülsamet; Karagöz, Hatice; Başak, Mustafa; Karahan, Samet; Çetinkaya, Ali; Avcı, Deniz; Bugǧday, İrfan

doi:10.2147/ijgm.s46383

Cited by 11 publications

(10 citation statements)

References 12 publications

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“…Cytotoxicity assays were performed using confluent mouse kidney M-1 collecting duct cell layers, which exhibited evidence of active water transport, i.e., “domes”, attributed to water transport between the cell layer and wellplate bottom [ 25 ]. Lithium ion is a known nephrotoxicant, whose mechanism of toxicity is related to the inhibition of AQP-2 transport to the cell membrane, thereby causing diabetes insipidus [ 39 ]. However, diabetes insipidus isn’t the major concern in this study versus lithium accumulation within the kidney, risk of renal fibrosis, and damage to various organelles; karyolysis and cell fragmentation were observed in the kidneys of rats exposed to lithium chloride [ 21 , 23 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

The Photoinitiator Lithium Phenyl (2,4,6-Trimethylbenzoyl) Phosphinate with Exposure to 405 nm Light Is Cytotoxic to Mammalian Cells but Not Mutagenic in Bacterial Reverse Mutation Assays

et al. 2020

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Lithium phenyl (2,4,6-trimethylbenzoyl) phosphinate (LAP) is a free radical photo-initiator used to initiate free radical chain polymerization upon light exposure, and is combined with gelatin methacryloyl (GelMA) to produce a photopolymer used in bioprinting. The free radicals produced under bioprinting conditions are potentially cytotoxic and mutagenic. Since these photo-generated free radicals are highly-reactive but short-lived, toxicity assessments should be conducted with light exposure. In this study, photorheology determined that 10 min exposure to 9.6 mW/cm2 405 nm light from an LED light source fully crosslinked 10 wt % GelMA with >3.4 mmol/L LAP, conditions that were used for subsequent cytotoxicity and mutagenicity assessments. These conditions were cytotoxic to M-1 mouse kidney collecting duct cells, a cell type susceptible to lithium toxicity. Exposure to ≤17 mmol/L (0.5 wt %) LAP without light was not cytotoxic; however, concurrent exposure to ≥3.4 mmol/L LAP and light was cytotoxic. No condition of LAP and/or light exposure evaluated was mutagenic in bacterial reverse mutation assays using S. typhimurium strains TA98, TA100 and E. coli WP2 uvrA. These data indicate that the combination of LAP and free radicals generated from photo-excited LAP is cytotoxic, but mutagenicity was not observed in bacteria under typical bioprinting conditions.

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Section: Discussionmentioning

confidence: 99%

The Photoinitiator Lithium Phenyl (2,4,6-Trimethylbenzoyl) Phosphinate with Exposure to 405 nm Light Is Cytotoxic to Mammalian Cells but Not Mutagenic in Bacterial Reverse Mutation Assays

et al. 2020

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“…This was confirmed by our study, since in the majority of cases, decline of renal function preceded lithium intoxication. Acute lithium exposure can lead to overt diabetes insipidus ( Erden et al, 2013 ) and consequently to dehydration. This may partly explain a transient increase of serum creatinine during the acute intoxication period.…”

Section: Discussionmentioning

confidence: 99%

Lithium intoxication: Incidence, clinical course and renal function – a population-based retrospective cohort study

et al. 2016

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When prescribing lithium, the risk of toxicity remains a concern. In this study, we examined a cohort of patients exposed to lithium between 1997 and 2013. The aims of this study were to determine the frequency of lithium intoxication and to evaluate the clinical course and changes in renal function. Of 1340 patients, 96 had experienced at least one episode of lithium levels ⩾1.5 mmol/L, yielding an incidence of 0.01 per patient-year. Seventy-seven patients available for review had experienced 91 episodes, of whom 34% required intensive care and 13% were treated with haemodialysis. There were no fatalities. Acute kidney injury occurred, but renal function at baseline was not different to renal function after the episode. Renal impairment was often associated with co-morbidities and other factors. Both intermittent and continuous-venovenous haemodialysis were used, but the clearance of continuous-venovenous haemodialysis can be too low in cases where large amounts of lithium have been ingested. Saline and forced diuresis have been used and are safe. Lithium intoxication seems rare and can be safely managed in most cases. Physicians should not withhold lithium for fear of intoxication in patients who benefit from it. Yet, physicians should have a low threshold to screen for toxicity.

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“…General medical conditions characterized by decreased circulating volume, including viral infections with fever, gastroenteritis with diarrhea and vomiting, great heat and sauna and decreased oral intake of water augment renal reabsorption of sodium and lithium, potentially leading to toxic lithium serum levels. In this respect, nephrogenic diabetes insipidus as a common side effect of chronic lithium treatment potentially causing intoxication has to be emphasized (Timmer and Sands 1999 ; Erden et al 2013 ). As a further potential cause of lithium intoxication suicide attempt has to be considered.…”

Section: Introductionmentioning

confidence: 99%

Treatment of lithium intoxication: facing the need for evidence

Haußmann

Bauer

Bonin

et al. 2015

Int J Bipolar Disord

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Lithium has been used as the gold standard in the treatment of major depressive and bipolar disorders for decades. Due to its narrow therapeutic index, lithium toxicity is a common clinical problem. Although risk factors for lithium intoxication seem to be well-described, lacking patient education and inexperience of treatment are assumed to contribute to the probability of lithium intoxication. A review of literature shows that the treatment of lithium intoxication has not been adequately studied or standardized. The aim of this literature review is to compile and present current evidence on the treatment of lithium intoxication and contribute to a standardization regarding general treatment recommendations as well as evidence on indication for extracorporeal methods. Against the background of this common and potentially life-threatening condition, the standardization of the treatment of lithium intoxication is definitely a task for the future.

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Lithium intoxication and nephrogenic diabetes insipidus: a case report and review of literature

Cited by 11 publications

References 12 publications

The Photoinitiator Lithium Phenyl (2,4,6-Trimethylbenzoyl) Phosphinate with Exposure to 405 nm Light Is Cytotoxic to Mammalian Cells but Not Mutagenic in Bacterial Reverse Mutation Assays

The Photoinitiator Lithium Phenyl (2,4,6-Trimethylbenzoyl) Phosphinate with Exposure to 405 nm Light Is Cytotoxic to Mammalian Cells but Not Mutagenic in Bacterial Reverse Mutation Assays

Lithium intoxication: Incidence, clinical course and renal function – a population-based retrospective cohort study

Treatment of lithium intoxication: facing the need for evidence

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