title: [Difficulty in determining when to end continuous hemodialysis for lithium intoxication: case report].
abstract: The patient was a 26-year-old woman who ingested a total of 230 tablets, including 160 lithium carbonate tablets (200 mg), in a suicide attempt, and was brought to our hospital 5 hr later. After arriving at the hospital, her only complaint was mild nausea, and no neurological abnormalities or renal dysfunction was observed. We were unable to learn the blood concentration of lithium immediately. A forced diuresis was performed after admission, but the nausea persisted. Continuous hemodialysis (CHD) was performed for 23.5 hr starting 19 hr after ingesting the tablets because the patient had ingested a large amount of lithium carbonate, 32,000 mg. Since the nausea resolved after the CHD was started and no manifestations of lithium intoxication had developed as of 91 hr after ingestion, the patient was discharged. The blood lithium concentrations (mEq/L) revealed at a later date showed that the concentration 5 hr (at the time of the initial examination), 19 hr (start of CHD), 44.5 hr (end of CHD), and 91 hr after ingestion (at the time of discharge) was 4.08, 3.30, 1.09, and 0.38, respectively. Blood purification is said to be effective in treating serious lithium intoxication, but it is difficult to judge when to stop. A favorable outcome of treatment of acute lithium intoxication in a patient with normal renal function appears to have been achieved by performing CHD guided by the clinical manifestations, intravascular redistribution times, etc.
authors.affiliation: Critical Care and Emergency Medical Center, Yokohama-City Minato Red Cross Hospital.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takahashi
authors.forename: Soichi
authors.initials: S
authors.lastname: Ito
authors.forename: Shiro
authors.initials: S
authors.lastname: Gonai
mesh_terms: D000328:Adult; D004232:Diuretics / Q000008:administration & dosage; D062787:Drug Overdose; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000097:blood / Q000506:poisoning*; D009325:Nausea / Q000139:chemically induced / Q000628:therapy; D006435:Renal Dialysis; D013406:Suicide, Attempted; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D016651:Lithium Carbonate