Increasing lithium concentration despite extracorporeal treatment: a case report

We describe a patient with bipolar disorder, a long history of lithium use, and chronic kidney disease (CKD) who developed lithium intoxication following an intentional overdose with multiple drugs. The patient was taken by ambulance to the hospital emergency department and arrived there  approximately 4 h after assumed ingestion. When toxicology screening was performed, the patient was found to have a lithium concentration of 2.7 mmol/L. Continuous venovenous hemofiltration (CVVH) was started, but lithium concentrations continued to rise. Intermittent hemodialysis (iHD) was ther efore introduced and continued until lithium concentrations dropped below 2.0 mmol/L. Lithium intoxication was not the initial focus of treatment, but, in retrospect, was the primary cause for admission. This case report shows that CVVH is an insufficient technique to remove lithium as concentratio ns continued to increase during its use. iHD should be used instead of CVVH and, especially in CKD patients, should be introduced immediately when lithium concentrations are >  2.5 mmol/L.
Source: Drugs and Therapy Perspectives - Category: Drugs & Pharmacology Source Type: research