lithium-chloride and Poisoning

Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.. El litio sigue siendo el tratamiento de elección en el trastorno bipolar. La intoxicación aguda por litio (IAL) es un cuadro potencialmente grave. Se presenta un estudio observacional, retrospectivo de las IAL observadas durante un periodo de 52 meses. Se definió como IAL cuando se registró una concentración de litio en sangre 1,5 mEq/L. Se analizaron sus características clínicas, epidemiológicas y su tratamiento de 70 episodios de IAL (densidad de incidencia: 1,76 IAL por cada 100 pacientes tratados-año). La causa más frecuente de IAL fue un proceso patológico intercurrente (46%). La mayoría fueron de carácter leve (74,2 %), con sintomatología neurológica en el 40,3%. En 8 IAL hubo alteraciones electrocardiográficas, 23 IAL (37,1%) se asociaron con fracaso renal agudo, la mayoría de carácter leve y 11 precisaron hemodiálisis. Se concluye que la IAL es una complicación infrecuente, pero es necesario disminuir su riesgo advirtiendo al paciente ante la existencia de procesos intercurrentes, errores en la posología o polimedicación.

Topics: Acute Disease; Acute Kidney Injury; Aged; Antidepressive Agents; Bipolar Disorder; Comorbidity; Female; Humans; Lithium Chloride; Male; Middle Aged; Nervous System Diseases; Poisoning; Renal Dialysis; Retrospective Studies

Lithium (Li) is a first-line treatment for bipolar disorder but has a narrow therapeutic index. Treatment of Li toxicity includes supportive measures and hemodialysis in severe cases, but this modality is not always immediately available. Sodium polystyrene sulfonate (SPS, Kayexalate), a cation exchanger, has been promising in animal models and human reports to reduce absorption and enhance elimination of Li.. A retrospective cohort study was conducted. All cases of chronic Li intoxication were reviewed in two adult-care hospitals from 2000 to 2009. A group comparison and a within-patient comparison were performed to compare the effect of SPS on the median Li half-life (T(1/2)). For this study, at least three serum Li levels were required for T(1/2) calculations.. Forty-eight patients met inclusion requirements, 12 of whom had taken SPS. Median Li T(1/2) in the treated and control groups was 20.5 and 43.2 hours, respectively (p = 0.0006). In the 12 treated patients, Li T(1/2) during SPS was on average 48.9% shorter than without SPS. Furthermore, in one subject in whom urinary Li data were available, Li clearance with SPS was superior to Li renal clearance. Prolonged constipation was noted in one patient whereas mild hypokalemia was noted in six patients treated with SPS.. This study shows that SPS reduced Li T(1/2) and suggests that SPS is capable of promoting Li elimination in chronic intoxications. These results warrant a prospective trial looking at the use of SPS in the treatment of Li overdose as an adjunct to supportive measures and hemodialysis.

Topics: Adult; Aged; Algorithms; Antidotes; Antimanic Agents; Area Under Curve; Cohort Studies; Drug Overdose; Female; Half-Life; Humans; Lithium Chloride; Male; Middle Aged; Poisoning; Polystyrenes; Retrospective Studies

Previous studies have shown that oral sodium polystyrene sulfonate lowers plasma lithium concentrations after acutely administered oral doses of lithium chloride. However, a significant proportion of lithium overdose cases resulting in morbidity and mortality are those in which exposure to lithium is chronic. This study was designed to determine whether multiple oral doses of sodium polystyrene sulfonate are effective in reducing plasma lithium concentrations after chronic dosing.. Placebo-controlled animal study.. One hundred thirty mice were given 75 mM lithium chloride in their drinking water for a period of 14 days. At the end of that period, half of the animals were given orogastric sodium polystyrene sulfonate at 5 g/kg/dose 0, 60, 120, 180, and 360 minutes after the cessation of lithium chloride; the remaining half received orogastric water at equivalent times. Subgroups of each group were sacrificed at 90, 150, 330, 480, 1440, and 2880 minutes after lithium chloride cessation and plasma analyzed for lithium content. Lithium concentrations were compared by analysis of variance and single degree of freedom contrasts. Significance was set at an alpha level of 0.05.. Lithium concentration was lower overall in the animals treated with sodium polystyrene sulfonate (p < .0001) and specifically at 150, 330, and 480 minutes after lithium chloride cessation (p < .05).. Repetitive oral doses of sodium polystyrene sulfonate effectively lowered plasma lithium concentrations. Further study may ultimately define a role for the use of sodium polystyrene sulfonate in the treatment of patients with chronic lithium toxicity.

Topics: Administration, Oral; Animals; Drug Overdose; Lithium; Lithium Chloride; Male; Mice; Poisoning; Polystyrenes; Random Allocation; Treatment Outcome

Anesthesia disrupts formation of conditioned taste aversion (CTA) when induced before presentation of the gustatory stimulus but does not prevent association of the already formed gustatory trace with delayed poisoning. The transition between the disruption-prone and disruption-resistant phases of CTA acquisition was examined under conditions eliminating the confounding effect of anesthesia on ingestive behavior. Intraperitoneal injection of 2% saccharin (1% b.wt.) was used as an intravascular gustatory conditioned stimulus (CS) followed 2 h later by the visceral unconditioned stimulus (US) (LiCl 0.15 mol/l, 2% b.wt.). Pentobarbital anesthesia (50 mg/kg) prevented CTA formation when applied 4 h before to 30 min after saccharin injection, but was ineffective in the second half of the CS-US interval (1-2 h after saccharin administration). CTA acquisition was also impaired by subanesthetic dosages of pentobarbital (10 and 20 mg/kg) preceding i.p. injection of saccharin. It is concluded that the abrupt disappearance of the disruptive effect of pentobarbital in the middle of the CS-US interval marks the formation of the gustatory trace which mediates CTA learning even when both CS and US are applied by i.p. injection.

Topics: Anesthesia; Animals; Avoidance Learning; Chlorides; Conditioning, Classical; Dose-Response Relationship, Drug; Lithium; Lithium Chloride; Male; Pentobarbital; Poisoning; Rats; Saccharin; Taste