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Hemodialysis for lithium poisoning
Eric J Lavonas1, Jennie Buchanan
1Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0108, Denver, Colorado, USA, 80204.
Insights
No randomized controlled trials support or refute hemodialysis for lithium poisoning. Current evidence is insufficient to determine if this treatment improves patient outcomes for neurological sequelae.
Area of Science:
- Nephrology
- Neurology
- Clinical Toxicology
Background:
- Lithium carbonate is a common treatment for bipolar disorder.
- Lithium poisoning can cause permanent neurological injury.
- Hemodialysis is a recommended treatment for lithium poisoning, but its efficacy is uncertain.
Purpose of the Study:
- To evaluate if hemodialysis improves outcomes in lithium poisoning.
- To determine if hemodialysis reduces neurological sequelae severity or duration.
Main Methods:
- Comprehensive literature search across multiple databases.
- Inclusion of randomized controlled trials comparing hemodialysis with standard care.
- Definition of hemodialysis to include extracorporeal techniques, excluding peritoneal dialysis.
Main Results:
- No randomized controlled trials were identified for hemodialysis in lithium poisoning.
- Existing observational studies are of low quality.
Conclusions:
- The use of hemodialysis for lithium poisoning is logical but lacks RCT evidence.
- Further research is needed to confirm the benefits of hemodialysis in managing lithium poisoning.
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.
Objectives:
To determine whether hemodialysis, applied in addition to standard therapy, reduces the likelihood, severity, or duration of neurological sequelae following lithium poisoning.
Search 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.
Selection Criteria:
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.
Data Collection And Analysis:
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.
Main Results:
No randomized controlled trials of hemodialysis therapy for lithium poisoning were identified.
Authors' 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.
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