Outcome of patients with lithium poisoning at a far-east poison center.
BACKGROUND
Lithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning.


METHODS
A total of 21 out of 7140 poisoned patients were referred for management of lithium poisoning between 2000 and 2009. Patients were stratified according to blood lithium level, that is mild-to-moderate (<2.5 mEq/L) or severe (≥2.5 mEq/L) poisoning. Demographic, clinical, and laboratory data were obtained for analysis. Mortality rates were also analyzed.


RESULTS
There were no significant differences between both groups for the baseline variables such as poisoning patterns, age, sex, smoking habit, alcohol consumption, or medical history of diabetes mellitus or hypertension (p > 0.05). Patients with severe poisoning had a greater distribution of severe neurological symptoms (mild/moderate/ severe: 11.1%/44.4%/44.4% versus 58.35%/16.65%/8.3%, p < 0.05), cardiovascular symptoms (66.6% versus 16.6%, p < 0.05), and renal impairment (urea nitrogen/creatinine: 27.1 ± 17.8/ 1.9 ± 1.3 mg/dL versus 14.1 ± 7.1/ 1.3 ± 0.6 mg/dL, p < 0.05) than patients with mild-to-moderate poisoning. Most patients were treated with saline diuresis (9 patients [100%] with severe poisoning versus 9 patients [75.0%] with mild-to-moderate poisoning, p > 0.05). Hemodialysis was initiated in 2 (22.2%) of 9 and 1 (8.3%) of 12 patients with severe and mild-to-moderate poisoning, respectively (p > 0.05). The treatment was successful and all patients recovered without chronic sequelae. Thus, these favorable outcomes were comparable to the data from other international Poison Centers.


CONCLUSIONS
Given the excellent outcomes of detoxification protocols, patients undergoing lithium therapy must be closely monitored for its toxicity and treated immediately in case of poisoning.
Lee
Yen-Ching
YC
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Lin
Ja-Liang
JL
Lee
Shen-Yang
SY
Hsu
Ching-Wei
CW
Weng
Cheng-Hao
CH
Chen
Yu-Hui
YH
Yang
Chih-Wei
CW
Yen
Tzung-Hai
TH
D000208:Acute Disease; D001714:Bipolar Disorder / Q000188:drug therapy; D002908:Chronic Disease; D004231:Diuresis; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D005751:Gastric Lavage; D006801:Humans; D018020:Lithium Compounds / Q000097:blood / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011041:Poisoning / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome
D018020:Lithium Compounds; D012462:Saline Solution, Hypertonic