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Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication

BACKGROUND: Lithium intoxication has potentially fatal neurologic and cardiac side effects. Extracorporeal removal can therefore be lifesaving. The dialysance of lithium is high as it is a small molecule. Comparable to its neighbor in the periodic table, sodium, its intracellular accumulation hamper...

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Autores principales: Schmidt, Julius J, Lorenzen, Johan, Chatzikyrkou, Christos, Lichtinghagen, Ralf, Kielstein, Jan T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172392/
https://www.ncbi.nlm.nih.gov/pubmed/25193402
http://dx.doi.org/10.1186/2050-6511-15-49
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author Schmidt, Julius J
Lorenzen, Johan
Chatzikyrkou, Christos
Lichtinghagen, Ralf
Kielstein, Jan T
author_facet Schmidt, Julius J
Lorenzen, Johan
Chatzikyrkou, Christos
Lichtinghagen, Ralf
Kielstein, Jan T
author_sort Schmidt, Julius J
collection PubMed
description BACKGROUND: Lithium intoxication has potentially fatal neurologic and cardiac side effects. Extracorporeal removal can therefore be lifesaving. The dialysance of lithium is high as it is a small molecule. Comparable to its neighbor in the periodic table, sodium, its intracellular accumulation hampers its removal by renal replacement therapy, despite its favorable size. For this reason the combination of short intermittent and prolonged dialysis may be a beneficial approach in acute lithium intoxication, yet only a report of such a combination has been published and actual removed lithium has not been quantified. CASE PRESENTATION: We describe the first measurement of lithium in the spent total dialysate treating an acute lithium overdose of a 44 year old Caucasian patient on chronic lithium therapy, undergoing extended dialysis. Extracorporeal therapy was initiated at a lithium serum concentration of 3.24 mmol/l. With blood/dialysate flow of 350 ml/min the 1.3 m(2) polysulfone dialyzer exhibited a maximum lithium clearance of 177 ml/min. After 4.1 hours of treatment the lithium level was lowered to 1.25 mmol/l. In the total spent dialysate 250 mg lithium, i.e. ~ 40% of the ingested amount were found. The subsequent extended dialysis over 9.5 hours further decreased serum levels to 0.79 mmol/l. Neurological symptoms improved within the first 60 min of treatment. The patient could be transferred to a psychiatric hospital on the morning after admission. CONCLUSION: Standard intermittent hemodialysis with subsequent extended dialysis can efficiently be employed in severe lithium intoxication by combining prompt a fast decrease of lithium blood levels and preventing rebound/assuring removal of redistributed lithium.
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spelling pubmed-41723922014-09-24 Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication Schmidt, Julius J Lorenzen, Johan Chatzikyrkou, Christos Lichtinghagen, Ralf Kielstein, Jan T BMC Pharmacol Toxicol Case Report BACKGROUND: Lithium intoxication has potentially fatal neurologic and cardiac side effects. Extracorporeal removal can therefore be lifesaving. The dialysance of lithium is high as it is a small molecule. Comparable to its neighbor in the periodic table, sodium, its intracellular accumulation hampers its removal by renal replacement therapy, despite its favorable size. For this reason the combination of short intermittent and prolonged dialysis may be a beneficial approach in acute lithium intoxication, yet only a report of such a combination has been published and actual removed lithium has not been quantified. CASE PRESENTATION: We describe the first measurement of lithium in the spent total dialysate treating an acute lithium overdose of a 44 year old Caucasian patient on chronic lithium therapy, undergoing extended dialysis. Extracorporeal therapy was initiated at a lithium serum concentration of 3.24 mmol/l. With blood/dialysate flow of 350 ml/min the 1.3 m(2) polysulfone dialyzer exhibited a maximum lithium clearance of 177 ml/min. After 4.1 hours of treatment the lithium level was lowered to 1.25 mmol/l. In the total spent dialysate 250 mg lithium, i.e. ~ 40% of the ingested amount were found. The subsequent extended dialysis over 9.5 hours further decreased serum levels to 0.79 mmol/l. Neurological symptoms improved within the first 60 min of treatment. The patient could be transferred to a psychiatric hospital on the morning after admission. CONCLUSION: Standard intermittent hemodialysis with subsequent extended dialysis can efficiently be employed in severe lithium intoxication by combining prompt a fast decrease of lithium blood levels and preventing rebound/assuring removal of redistributed lithium. BioMed Central 2014-09-06 /pmc/articles/PMC4172392/ /pubmed/25193402 http://dx.doi.org/10.1186/2050-6511-15-49 Text en Copyright © 2014 Schmidt et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Schmidt, Julius J
Lorenzen, Johan
Chatzikyrkou, Christos
Lichtinghagen, Ralf
Kielstein, Jan T
Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title_full Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title_fullStr Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title_full_unstemmed Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title_short Total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
title_sort total collected dialysate lithium concentration after successful dialysis treatment in case of intoxication
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172392/
https://www.ncbi.nlm.nih.gov/pubmed/25193402
http://dx.doi.org/10.1186/2050-6511-15-49
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