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Lithium Poisoning

Baird-Gunning, Jonathan; Lea-Henry, Tom N; Hoegberg, Lotte; Gosselin, Sophie; Roberts, Darren

Description

Lithium is a commonly prescribed treatment for bipolar affective disorder. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Therefore, careful attention to dosing, monitoring, and titration is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually...[Show more]

dc.contributor.authorBaird-Gunning, Jonathan
dc.contributor.authorLea-Henry, Tom N
dc.contributor.authorHoegberg, Lotte
dc.contributor.authorGosselin, Sophie
dc.contributor.authorRoberts, Darren
dc.date.accessioned2020-12-20T20:57:11Z
dc.date.available2020-12-20T20:57:11Z
dc.identifier.issn0885-0666
dc.identifier.urihttp://hdl.handle.net/1885/218189
dc.description.abstractLithium is a commonly prescribed treatment for bipolar affective disorder. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Therefore, careful attention to dosing, monitoring, and titration is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination. This is most commonly due to impaired kidney function caused by volume depletion from lithium-induced nephrogenic diabetes insipidus or intercurrent illnesses and is also drug-induced. Lithium poisoning can affect multiple organs; however, the primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Lithium poisoning has a low mortality rate; however, chronic lithium poisoning can require a prolonged hospital length of stay from impaired mobility and cognition and associated nosocomial complications. Persistent neurological deficits, in particular cerebellar, are described and the incidence and risk factors for its development are poorly understood, but it appears to be uncommon in uncomplicated acute poisoning. Lithium is readily dialyzable, and rationale support extracorporeal treatments to reduce the risk or the duration of toxicity in high-risk exposures. There is disagreement in the literature regarding factors that define patients most likely to benefit from treatments that enhance lithium elimination, including specific plasma lithium concentration thresholds. In the case of extracorporeal treatments, there are observational data in its favor, without evidence from randomized controlled trials (none have been performed), which may lead to conservative practices and potentially unnecessary interventions in some circumstances. More data are required to define the risk-benefit of extracorporeal treatments and their use (modality, duration) in the management of lithium poisoning
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherSage Science Press
dc.sourceJournal of Intensive Care Medicine
dc.titleLithium Poisoning
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume32
dc.date.issued2017
local.identifier.absfor111506 - Toxicology (incl. Clinical Toxicology)
local.identifier.ariespublicationa383154xPUB5795
local.type.statusPublished Version
local.contributor.affiliationBaird-Gunning, Jonathan, College of Health and Medicine, ANU
local.contributor.affiliationLea-Henry, Tom N, The Canberra Hospital
local.contributor.affiliationHoegberg, Lotte, Bispebjerg University Hospital
local.contributor.affiliationGosselin, Sophie, McGill University Health Centre
local.contributor.affiliationRoberts, Darren, College of Health and Medicine, ANU
local.bibliographicCitation.issue4
local.bibliographicCitation.startpage249
local.bibliographicCitation.lastpage263
local.identifier.doi10.1177/0885066616651582
dc.date.updated2020-11-23T10:45:42Z
local.identifier.scopusID2-s2.0-85018354558
local.identifier.thomsonID000399757100002
CollectionsANU Research Publications

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