Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study.
When prescribing lithium, the risk of toxicity remains a concern. In this study, we examined a cohort of patients exposed to lithium between 1997 and 2013. The aims of this study were to determine the frequency of lithium intoxication and to evaluate the clinical course and changes in renal function. Of 1340 patients, 96 had experienced at least one episode of lithium levels ⩾1.5 mmol/L, yielding an incidence of 0.01 per patient-year. Seventy-seven patients available for review had experienced 91 episodes, of whom 34% required intensive care and 13% were treated with haemodialysis. There were no fatalities. Acute kidney injury occurred, but renal function at baseline was not different to renal function after the episode. Renal impairment was often associated with co-morbidities and other factors. Both intermittent and continuous-venovenous haemodialysis were used, but the clearance of continuous-venovenous haemodialysis can be too low in cases where large amounts of lithium have been ingested. Saline and forced diuresis have been used and are safe. Lithium intoxication seems rare and can be safely managed in most cases. Physicians should not withhold lithium for fear of intoxication in patients who benefit from it. Yet, physicians should have a low threshold to screen for toxicity.
Department of Public Health and Clinical Medicine - Medicine, University Hospital, Umeå, Sweden author@ottm.eu.
Michael
M
Ott
Department of Public Health and Clinical Medicine - Medicine, University Hospital, Umeå, Sweden.
Bernd
B
Stegmayr
Department of Clinical Sciences - Psychiatry, University Hospital, Umeå, Sweden.
Ellinor
E
Salander Renberg
Sunderby Research Unit - Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
Ursula
U
Werneke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests / Q000379:methods; D008094:Lithium / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D008094:Lithium
Lithium; bipolar affective disorder; haemodialysis; intoxication; renal impairment