Keywords: Hemodialysis, lithium (PubMed Search)
Posted: 11/16/2017 by Kathy Prybys, DO
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Lithium salts have been used therapeutically for over a 150 years to sucessfully treat manic depressive symptoms, schizoaffective disorder, and cluster headaches. Lithium has a narrow therapeutic range (0.6-1.5 meq/L) and is 100% eliminated by the kidneys. Multisystem toxicity occurs however CNS toxicity is significant and consist of confusion, lethargy, ataxia, neuromuscular excitability (tremor, fasciculations, myoclonic jerks, hyperreflexia). Since there is a poor relationship between serum concentration and toxicity in the brain, serum blood levels may not reflect extent of toxicity . The goal of enhanced elimination is to prevent irreversible lithium-effectuated neurotoxcity which causes persistant cerebellar dysfunction with prolonged exposure of the CNS to high lithium levels.
Decision for hemodialysis is determined by clinical judgement after considering factors such as lithium concentration, clinical status of patient, pattern of lithium toxicity (acute vs. chronic), concurrent interacting drugs, comorbid illnesses, and kidney function. Strongly consider hemodialysis for the following:
Extracorpeal treatment for Lithoum Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Decker BS, et al. Clin Am Soc Nephrology 2015 Jan
The Syndrome of irreversible lithium-effectuated neurotoxicity. Adityjee, et al. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.
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