Lithium treatment in Aarhus. 2. Risk of renal failure and of intoxication

In a region around Aarhus with a population of 372,000 the total exposure time for patients in lithium treatment during the period 1979-1987 was about 4900 patient-years. Lithium intoxication developed in 24 patients. Fifteen intoxications were caused by deliberate self-poisoning and nine by neglect of treatment guidelines; none were caused by a decline of glomerular filtration rate or without discernible cause. Only two out of 234 systematically followed patients showed a consistently falling creatinine clearance; a causal relation to the therapy was doubtful. The authors' data analysis confirms that lithium treatment, even when given for many years, induces neither deterioration of the glomerular filtration rate nor renal failure. The observations further show that lithium intoxications do not develop capriciously; unintended intoxications can be avoided by adherence to treatment guidelines and precautions.