title: Hemodialysis for lithium poisoning.
abstract: BACKGROUND
  Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is often recommended to treat lithium poisoning. Although hemodialysis clearly enhances the elimination of lithium, it is unclear whether this translates into improved patient outcomes. Evidence from observational studies, generally of low methodological quality, shows similar outcomes in patients managed with or without the use of hemodialysis.
  
  
  OBJECTIVE
  To determine whether hemodialysis, applied in addition to standard therapy, reduces the likelihood, severity, or duration of neurological sequelae following lithium poisoning.
  
  
  METHODS
  We ran the search on 15 May 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase Classic+Embase (OvidSP), CINAHL Plus, clinical trials registers and four other databases. We screened the reference lists of relevant studies, textbook chapters, and review articles, and performed a Google search to identify grey literature.
  
  
  METHODS
  In the context of this review, hemodialysis was defined as any extracorporeal technique to filter and extract toxicants from the serum, including all forms of hemodialysis, hemofiltration, and continuous renal replacement techniques, but not peritoneal dialysis. We included any clinical trials in which patients were randomly allocated to receive, or not receive, hemodialysis in addition to standard care for lithium poisoning.
  
  
  METHODS
  Two authors reviewed the abstracts of all identified articles. If either author identified an article as potentially meeting the inclusion criteria, both authors reviewed the full text of the article.
  
  
  RESULTS
  No randomized controlled trials of hemodialysis therapy for lithium poisoning were identified.
  
  
  CONCLUSIONS
  Although the use of hemodialysis to enhance the elimination of lithium in patients with lithium poisoning appears logical, there is no evidence from randomized controlled trials to support nor refute the use of hemodialysis in the management of patients with lithium poisoning.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0108, Denver, Colorado, USA, 80204.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lavonas
authors.forename: Jennie
authors.initials: J
authors.lastname: Buchanan
mesh_terms: D006801:Humans; D016651:Lithium Carbonate / Q000506:poisoning; D018020:Lithium Compounds / Q000506:poisoning*; D011041:Poisoning / Q000628:therapy; D006435:Renal Dialysis
chemical_list: D018020:Lithium Compounds; D016651:Lithium Carbonate