Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication

BMC Clinical Pharmacology

Jan T Kielstein²  Ralf Lichtinghagen¹  Christos Chatzikyrkou²  Johan Lorenzen²  Julius J Schmidt² 

[1] Institute of Clinical Chemistry, Medical School Hannover, Hannover, Germany;Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany

关键词: Extended dialysis;    Drug monitoring;    Intensive care unit;    Intoxication;    Lithium;   

Others  :  1084785
DOI  :  10.1186/2050-6511-15-49

 received in 2014-01-14, accepted in 2014-08-26,  发布年份 2014

【 摘 要 】

Background

Lithium intoxication has potentially fatal neurologic and cardiac side effects. Extracorporeal removal can therefore be lifesaving. The dialysance of lithium is high as it is a small molecule. Comparable to its neighbor in the periodic table, sodium, its intracellular accumulation hampers its removal by renal replacement therapy, despite its favorable size. For this reason the combination of short intermittent and prolonged dialysis may be a beneficial approach in acute lithium intoxication, yet only a report of such a combination has been published and actual removed lithium has not been quantified.

Case presentation

We describe the first measurement of lithium in the spent total dialysate treating an acute lithium overdose of a 44 year old Caucasian patient on chronic lithium therapy, undergoing extended dialysis. Extracorporeal therapy was initiated at a lithium serum concentration of 3.24 mmol/l. With blood/dialysate flow of 350 ml/min the 1.3 m² polysulfone dialyzer exhibited a maximum lithium clearance of 177 ml/min. After 4.1 hours of treatment the lithium level was lowered to 1.25 mmol/l. In the total spent dialysate 250 mg lithium, i.e. ~ 40% of the ingested amount were found. The subsequent extended dialysis over 9.5 hours further decreased serum levels to 0.79 mmol/l. Neurological symptoms improved within the first 60 min of treatment. The patient could be transferred to a psychiatric hospital on the morning after admission.

Conclusion

Standard intermittent hemodialysis with subsequent extended dialysis can efficiently be employed in severe lithium intoxication by combining prompt a fast decrease of lithium blood levels and preventing rebound/assuring removal of redistributed lithium.

【 授权许可】

   
2014 Schmidt et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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