LITHIUM INTOXICATION - (REPORT OF 23 CASES AND REVIEW OF 100 CASES FROM LITERATURE)

Abstract

Twenty-three patients were studied, 21 of whom developed intoxication during maintenance therapy with a Li [used in treatment of depression] dosage which had been unchanged for months to years. Toxic effects on brain, heart and kidneys were found; the severity of Li intoxication seemed to depend on at least 3 factors: the height of the serum Li concentration (SLi), the duration of Li intoxication and individual tolerance. Disorders of H2O and electrolyte metabolism preceded Li intoxication in the majority of the patients. H2O loss due to impaired renal concentrating ability seemed to be a major predisposing factor. Renal insufficiency was apparent in 17 of the patients on admission and 5 of these did not regain normal renal function. In 7 patients, renal biopsy showed abnormalities, suggesting that a chronic nephropathy, possibly caused by Li, might be another predisposing factor. Treatment with NaCl infusion had no specific effect on Li excretion and led to hypernatremia in some patients and is therefore not recommended. Hemodialysis is the most effective method available for removing the Li ion from intoxicated patients. Hemodialysis should be carried out long enough to secure a SLi of less than 1 mmol/1 after redistribution of Li in the body. Treatment by peritoneal dialysis is appropriate only if hemodialysis facilities are unavailable. Li intoxication is a serious condition. Of the 23 patients reported, 2 died and 2 developed persisting neurological sequelae. The best way to prevent Li intoxication is to control the serum concentration and to assess renal function and renal concentrating ability regularly during therapy.