title: Bayesian pharmacokinetics of lithium after an acute self-intoxication and subsequent haemodialysis: a case report.
abstract: 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.
authors.affiliation: Department of Pharmacy and Pharmacology, Amsterdam, The Netherlands. Thomas_Kerbusch@sandwich.pfizer.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerbusch
authors.forename: Ron A A
authors.initials: RA
authors.lastname: Mathôt
authors.forename: Hans M M B
authors.initials: HM
authors.lastname: Otten
authors.forename: Eelco W
authors.initials: EW
authors.lastname: Meesters
authors.forename: Hendrikus J M
authors.initials: HJ
authors.lastname: van Kan
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Schellens
authors.forename: Jos H
authors.initials: JH
authors.lastname: Beijnen
mesh_terms: 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
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D005473:Fluoxetine; D008094:Lithium; D018967:Risperidone; D008140:Lorazepam