Lithium: one drug, five complications

Delannoy, P.; Boussekey, Nicolas; Thellier, Damien; Georges, Hugues; Leroy, Olivier

doi:10.1186/s40560-017-0257-5

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…Lithium amount in dialysates correspond to 90% of total lithium excreted during CCVHF session while urine excretion account only for 10% during the same period. Our results proved the great efficacy of CCVDF and confirmed that the best method to treat severe lithium acute poisoning without plasma rebounds (5,12,13).…”

Section: Discussionsupporting

confidence: 76%

“…In return for its wide therapeutic use, lithium is still at the origin of numerous poisonings, mainly in a context of chronic drug accumulation, but self-administration of toxic doses may account for 20-27% of the hospitalized poisoning (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…Using repeated hemodialysis (HD) sessions, concentration rebounds are usually observed at the end of HD session due to organs from extracellular fluids redistribution (13). Continuous extrarenal epuration by veno-venous hemodiafiltration (CCVHDF) is now frequently reported to treat severe lithium poisoning and better control of lithium concentration rebounds (5,13).…”

Section: Introductionmentioning

confidence: 99%

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

Jamal

Hennequin

Gahoual

et al. 2019

Journal of Analytical Toxicology

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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%.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Jamal

Hennequin

Gahoual

et al. 2019

Journal of Analytical Toxicology

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“…8 Intensive care unit admission with intubation may also be required during times that clinically suggest an impending central nervous system failure such as impaired consciousness, seizures and coma. 14…”

Section: Discussionmentioning

confidence: 99%

Accidental chronic lithium toxicity

Kanellis¹,

Varendran²

2018

Int J Basic Clin Pharmacol

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Lithium is an effective first-line mood stabiliser for bipolar disorder, treatment-refractory depression and suicide prevention. Studies have demonstrated its ability to produce neuroprotective benefits. Despite this, Lithium can cause neurotoxicity, cardiotoxicity and endocrine derangement resulting in severe (and potentially permanent) side effects. Lithium toxicity can be precipitated by illness, salt restriction diets, dehydration, nephrogenic diabetes insipidus, impaired creatinine clearance, concomitant drugs. This is particularly true in older patients with altered pharmacodynamics and pharmacokinetics. We present a 52-year-old female who presented with prolonged signs of lithium toxicity post-diarrhoea. Lack of monitoring due to her nomadic life-style resulted in the combination of long-lasting neurotoxicity and thyroid dysfunction. Our patient displayed neurotoxicity that was not present on imaging. This highlights the importance of regular monitoring of renal function, lithium serum levels and neuro-endocrine function to reduce complications associated with lithium toxicity.

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“…Konfusion, epileptische Anfälle) unterschieden [4]. Das klinische Bild einer Intoxikation kann zudem von internistischen und kardiologischen/ nephrologischen Symptomen überlagert werden [4][5][6][7].…”

Section: Diskussionunclassified