Clinical manifestations and management of acute lithium intoxication

doi:10.1016/0002-9343(94)90308-5

The American Journal of Medicine

Volume 97, Issue 4, October 1994, Pages 383-389

https://doi.org/10.1016/0002-9343(94)90308-5 Get rights and content

Abstract

Acute lithium intoxication is a frequent complication of chronic lithium therapy for manic depressive disorders. Because of lithium's narrow therapeutic index and widespread use, lithium intoxication remains prevalent in 1994. This review summarizes information on the renal handling of lithium and the physiologic basis for toxicity. Recent reports that describe previously unrecognized side effects of lithium intoxication are discussed. We also present management guidelines based upon our understanding of the renal handling of lithium. In this review we compare the effectiveness of lithium removal by various dialysis methods, including bicarbonate dialysis, peritoneal dialysis and continuous arteriovenous hemofiltration. Hemodialysis remains the cornerstone for the treatment of acute lithium toxicity.

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ReviewClinical manifestations and management of acute lithium intoxication

Abstract

J Psychiat.

Kidney Int.

Lancet

Lancet

Am J Med

Am J Med

Am J Med

Am Heart J

BMJ

Ann Emerg Med

Psychiatr Clin North Am

Lithium in mania

Clin Pharmacol Ther.

Prophylactic lithium; double blind discontinuation in manic depressive and recurrent depressive disorders

Lancet

Lithium in mania

Lithium intoxication

Q J Med.

Biological membranes: The physical basis of ion and nonelectrolyte selectivity

Ann Rev Physiol.

How do biological systems discriminate among physically similar ions?

J Exp Zool.

Drugs and the treatment of psychiatric disorders

The distribution of lithium into cerebrospinal fluid, brain tissue and bile in man

Int J Clin Pharmacol Biopharm.

Lithium, membranes and manic-depressive illness

J Membr Biol.

Monitoring of lithium treatment through determination of lithium concentration

Dan Med Bull.

Estimation of pharmacokinetic parameters of lithium from saliva and urine

Clin Pharmacol Ther.

Pharmacokinetics of ordinary and sustained—release lithium carbonate in manic patients after acute dosage

Eur J Clin Pharmacol.

Lithium salts: 1970–1975

Ann Intern Med.

Lithium elimination half-life and duration of therapy

Clin Pharmacol Ther.

Lithium studies

Lithium concentration by the thyroid

Endocrinol.

Renal lithium excretion in man

Am J Physiol.

Red-cell lithium-sodium countertransport and renal lithium clearance in hypertension

NEJM

A micropuncture study of the renal handling of lithium

Pflugers Arch.

On the mechanism of lithium-induced diabetes insipidus in man and rats

J Clin Invest.

Lithium clearance in mineralocorticoid escape in humans

Am J Physiol.

The renal handling of lithium: relation between lithium clearance, sodium clearance & urine flow in rats with diabetes insipidus

Acta Pharmacol Toxicol

Acute effects of various diuretics on lithium clearance, studies in rats on medium and low sodium diet

Renal Physiol.

Lithium clearance: modification by the loop of Henle in man

J Physiol.

Lithium as a marker for proximal tubule delivery during low salt intake and diuretic infusion

Am J Physiol.

Acute effect of diuretics on lithium clearance

Renal Physiol.

Lithium poisoning

Am J Psychiatry

Severe lithium toxicity with “normal” serum concentrations

BMJ

Value of lithium plasma concentration in severe lithium intoxication

Anaesthesiol Belg.

Extreme lithium intoxication without severe symptoms

Hosp Community Psychiatry

Toxicity of lithium carbonate in elderly patients

Am J Psychiatry

Neurotoxicity with lithium: differential drug responsiveness

Int Pharmacopsychiatry J.

Sodium intake and lithium treatment in mania

Am J Psychiatry

Effect of prolonged thiazide treatment on renal lithium clearance

BMJ

Renal lithium reabsorption in man: physiologic and pharmacologic determinants

Am J Med Sci.

Review
Clinical manifestations and management of acute lithium intoxication