Lithium poisoning from a poison control center perspective.

Area of Science:

• Toxicology
• Clinical Pharmacology
• Emergency Medicine

Background:

• Lithium is a mood stabilizer with a narrow therapeutic index.
• Lithium poisoning can occur in acute or chronic overdose settings.
• Accurate assessment of poisoning severity is crucial for patient management.

Purpose of the Study:

• To evaluate lithium poisoning severity in a poison control center population.
• To assess the correlation of the Hansen and Amdisen classification with patient outcomes and lithium levels.
• To determine the clinical utility of the Hansen and Amdisen scale in lithium poisoning.

Main Methods:

• Prospective observation of all lithium overdoses reported to a poison control center over one year.
• Data collection included demographics, ingestion details, co-ingestants, clinical presentation, lithium levels, treatment, and outcomes.
• Classification of poisoning severity using the Hansen and Amdisen scale.

Main Results:

• 12 acute overdoses: no deaths or sequelae. 174 acute-on-chronic overdoses: 1 death. 19 chronic poisonings: 1 death and 1 case of sequelae.
• Hemodialysis was required in 6 acute-on-chronic and 3 chronic poisoning cases.
• Grade 2 lithium poisoning showed significantly higher lithium levels than Grade 1 in acute cases (P=0.03).

Conclusions:

• Lithium poisoning is associated with rare morbidity (0.5%) and mortality (1%).
• The Hansen and Amdisen classification demonstrated poor correlation with lithium levels and did not effectively predict morbidity or mortality.
• The Hansen and Amdisen classification may not be a useful clinical tool for managing lithium poisoning.