Bayesian pharmacokinetics of lithium after an acute self-intoxication and subsequent haemodialysis: a case report.
We report a case of a 39-year-old male with bipolar affective disorder who was admitted to hospital with an intentional acute lithium intoxication resulting in renal insufficiency. The patient had previously been treated with lithium, risperidone, fluoxetine and lorazepam, and successfully titrated to lithium levels of 0.7 mmol/l. After overdosing, the lithium level was 5.89 mmol/l and haemodialysis was initiated. A full pharmacokinetic time profile of lithium was obtained. After successful haemodialysis treatment, lithium levels recovered below toxic levels of 1.5 mmol/l in 53 hr. Without intervention non-toxic levels were not expected to have been reached within 6 days, based on computer simulation of predialysis levels. The patient was discharged 6 days after admission without residual symptoms. It was concluded that the lithium intoxication resulted from a combination of lithium overdose and subsequent renal insufficiency due to the overdose. A possible fluoxetine-risperidone interaction was not considered clinically apparent.
Kerbusch
Thomas
T
Department of Pharmacy and Pharmacology, Amsterdam, The Netherlands. Thomas_Kerbusch@sandwich.pfizer.com
Mathôt
Ron A A
RA
Otten
Hans M M B
HM
Meesters
Eelco W
EW
van Kan
Hendrikus J M
HJ
Schellens
Jan H M
JH
Beijnen
Jos H
JH
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D018692:Antimanic Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000506:poisoning*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001499:Bayes Theorem; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D008094:Lithium / Q000097:blood / Q000493:pharmacokinetics* / Q000506:poisoning*; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008954:Models, Biological; D006435:Renal Dialysis; D018967:Risperidone / Q000627:therapeutic use; D013406:Suicide, Attempted
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D005473:Fluoxetine; D008094:Lithium; D018967:Risperidone; D008140:Lorazepam