Lithium induced hypercalcemia: an expert opinion and management algorithm

International Journal of Bipolar Disorders

Research

Lars Vedel Kessing¹  Janusz Rubakowski²  Peter Vestergaard³  Gabriele Sani⁴  Ute Lewitzka⁵  Phillip Ritter⁵  Michael Bauer⁵  Tomas Hajek⁶  Martin Alda⁶  Veerle Bergink⁷  Florian Seemueller⁸  Anne Duffy⁹  Allan H. Young^1,10  Bruno Müller-Oerlinghausen^1,11  Leonardo Tondo^1,12  Paul Grof^1,13  René Ernst Nielsen^1,14  Sune P. V. Straszek^1,14  Rasmus W. Licht^1,14  Anne Sofie Hansen^1,14  Zoltan Kovacs^1,14  Josef Priller^1,15  Mirko Manchia^1,16 

[1] Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark;Department of Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark;Steno Diabetes Center North Jutland, Aalborg, Denmark;Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy;Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy;Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany;Department of Psychiatry, Dalhousie University, Halifax, Canada;National Institute of Mental Health, Klecany, Czech Republic;Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA;Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands;Department of Psychiatry, Psychotherapy, Psychosomatics and Neuropsychiatry, Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Auenstr.6, 82467, Garmisch-Partenkirchen, Germany;Department of Psychiatry, Queen’s University, Kingston, ON, Canada;Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, BR3 3BX, Beckenham, Kent, UK;Medical Faculty Brandenburg Theodor Fontane, Neuruppin, Germany;Mood Disorder Centro Lucio Bini, Cagliari, Italy;Rome McLean Hospital, Harvard Medical School, Rome, Italy;Mood Disorders Center, Ottawa, ON, Canada;University of Toronto, Toronto, ON, Canada;Psychiatry, Research and Treatment Program for Bipolar Disorder, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, 81675, Munich, Germany;Charité-Universitätsmedizin Berlin and DZNE, 10117, Berlin, Germany;University of Edinburgh and UK DRI, EH16 4SB, Edinburgh, UK;Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK;Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy;Department of Pharmacology, Dalhousie University, Halifax, NS, Canada;Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy;

关键词: Lithium;    Side-effects;    Bipolar disorder;    Affective disorder;   

DOI  :  10.1186/s40345-022-00283-3

 received in 2022-09-18, accepted in 2022-12-19,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundLithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking.MethodsBased on a narrative review of the effects of lithium on calcium and parathyroid hormone (PTH) homeostasis and its clinical implications, experts developed a step-by-step algorithm to guide the initial management of emergent hypercalcemia during lithium treatment.ResultsIn the event of albumin-corrected plasma calcium levels above the upper limit, PTH and calcium levels should be measured after two weeks. Measurement of PTH and calcium levels should preferably be repeated after one month in case of normal or high PTH level, and after one week in case of low PTH level, independently of calcium levels. Calcium levels above 2.8 mmol/l may require a more acute approach. If PTH and calcium levels are normalized, repeated measurements are suggested after six months. In case of persistent PTH and calcium abnormalities, referral to an endocrinologist is suggested since further examination may be needed.ConclusionsStandardized consensus driven management may diminish the potential risk of clinicians avoiding the use of lithium because of uncertainties about managing side-effects and consequently hindering some patients from receiving an optimal treatment.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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