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Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study
Michael Ott1, Bernd Stegmayr2, Ellinor Salander Renberg3
1Department of Public Health and Clinical Medicine - Medicine, University Hospital, Umeå, Sweden author@ottm.eu.
Journal of Psychopharmacology (Oxford, England)
|June 17, 2016
Summary
Lithium intoxication is rare, occurring at an incidence of 0.01 per patient-year. Most cases can be safely managed, with no fatalities observed, suggesting lithium therapy should not be withheld due to toxicity fears.
Area of Science:
- Nephrology
- Clinical Pharmacology
- Toxicology
Background:
- Lithium is a crucial medication for bipolar disorder, but its therapeutic index is narrow, raising concerns about toxicity.
- Monitoring lithium levels is essential to prevent adverse events and ensure patient safety.
Purpose of the Study:
- To determine the incidence of lithium intoxication in a patient cohort.
- To evaluate the clinical course, management, and renal function changes associated with lithium toxicity.
Main Methods:
- Retrospective cohort study of patients exposed to lithium between 1997 and 2013.
- Analysis of lithium levels, clinical outcomes, and renal function parameters.
Main Results:
- An incidence of lithium levels >= 1.5 mmol/L was 0.01 per patient-year.
- 34% of intoxication episodes required intensive care, and 13% received haemodialysis; no fatalities occurred.
- Acute kidney injury was observed, but renal function generally returned to baseline; comorbidities influenced renal impairment.
Conclusions:
- Lithium intoxication is rare and typically manageable, with saline and forced diuresis being safe interventions.
- Physicians should maintain a low threshold for screening lithium toxicity without withholding beneficial treatment.
- Continuous-venovenous haemodialysis may have insufficient clearance for significant lithium overdose.
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