Must-read post: Why dialyze patients with chronic, asymptomatic hyperlithemia?

About a month ago I discussed a new state-of-the-art review of lithium poisoning, which I rated “four skulls” and called a near must-read. Now comes a superb post entitled “Why dialyze patients with chronic, asymptomatic hyperlithemia” from Josh Farkas from PulmCrit.org and emcrit.org. It is essential reading for all clinicians who deal with lithium poisoned patients. Dr. Farkas makes the following important points: A single lithium level, not correlated with the patient’s clinical condition or history, does not provide much useful information. The serum lithium level does not correlate well with the CNS level, which is the really important parameter. “Using any single lithium level to trigger dialysis is absurd.” There is no evidence to support dialysis for chronic asymptomatic hyperlithemia, no matter what the level. Guidelines that mandate dialysis based solely on lithium levels (we’re looking at YOU, ExTRIP Workgroup) suffer from failing to admit uncertainty and coming to terms with the lack of good evidence on the topic. The key conclusion: “There is no evidence to support the use of dialysis in stable patients with chronic asymptomatic hyperlithemia . . . A sensible approach to chronic asymptomatic hyperlithemia in a patient with adequate renal function might be rehydration with close monitoring of lithium and clinical status.” Very well put. Also, don’t miss the comments section of the post, where th...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical chronic extrip hemodialysis lithium poisoning Source Type: news