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      Lithium overdosage and related tests

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          Abstract

          Lithium acts biochemically through the inositol depletion in brain cortex. At low doses, however, it is partly effective and/or ineffective, whereas in high concentrations is toxic. We would like to make one point about this review. In fact, in our view, the patient should be given a support to correct hypernatremia and even sodium levels should be tested serially—along with serum lithium concentrations—because high sodium levels reduce the rate of elimination of lithium. Lithium is mainly a neurotoxicant. Lithium-related central nervous system toxicity as well as the cardiovascular and thyroid changes are most likely due to the cations (Na 2 + and K +) competition.

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          Lithium nephrotoxicity revisited.

          Bernard C Rossier, Jean-Pierre Grünfeld (2009)
          Lithium is widely used to treat bipolar disorder. Nephrogenic diabetes insipidus (NDI) is the most common adverse effect of lithium and occurs in up to 40% of patients. Renal lithium toxicity is characterized by increased water and sodium diuresis, which can result in mild dehydration, hyperchloremic metabolic acidosis and renal tubular acidosis. The concentrating defect and natriuretic effect develop within weeks of lithium initiation. After years of lithium exposure, full-blown nephropathy can develop, which is characterized by decreased glomerular filtration rate and chronic kidney disease. Here, we review the clinical and experimental evidence that the principal cell of the collecting duct is the primary target for the nephrotoxic effects of lithium, and that these effects are characterized by dysregulation of aquaporin 2. This dysregulation is believed to occur as a result of the accumulation of cytotoxic concentrations of lithium, which enters via the epithelial sodium channel (ENaC) on the apical membrane and leads to the inhibition of signaling pathways that involve glycogen synthase kinase type 3beta. Experimental and clinical evidence demonstrates the efficacy of the ENaC inhibitor amiloride for the treatment of lithium-induced NDI; however, whether this agent can prevent the long-term adverse effects of lithium is not yet known.
          Article 0 comments Cited 71 times – based on 0 reviews     Review now
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            Lithium intoxication.

            Jorik Timmer, Barbara J Sands (1999)
            Article 0 comments Cited 37 times – based on 0 reviews     Review now
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              Treatment of lithium intoxication: facing the need for evidence

              R. Haussmann, M Bauer, S. von Bonin … (2015)
              Lithium has been used as the gold standard in the treatment of major depressive and bipolar disorders for decades. Due to its narrow therapeutic index, lithium toxicity is a common clinical problem. Although risk factors for lithium intoxication seem to be well-described, lacking patient education and inexperience of treatment are assumed to contribute to the probability of lithium intoxication. A review of literature shows that the treatment of lithium intoxication has not been adequately studied or standardized. The aim of this literature review is to compile and present current evidence on the treatment of lithium intoxication and contribute to a standardization regarding general treatment recommendations as well as evidence on indication for extracorporeal methods. Against the background of this common and potentially life-threatening condition, the standardization of the treatment of lithium intoxication is definitely a task for the future.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Paolo D. Pigatto: gianpaolo_guzzi@fastwebnet.it
                Bernardo Dell’Osso: gianpaolo_guzzi@fastwebnet.it
                Gianpaolo Guzzi: +39-02-782 561 , gianpaolo_guzzi@fastwebnet.it
                Journal
                Journal ID (nlm-ta): Int J Bipolar Disord
                Journal ID (iso-abbrev): Int J Bipolar Disord
                Title: International Journal of Bipolar Disorders
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 2194-7511
                Publication date (Electronic): 12 January 2016
                Publication date PMC-release: 12 January 2016
                Publication date Collection: 2016
                Volume: 4
                Electronic Location Identifier: 1
                Affiliations
                [ ]Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy
                [ ]Fondazione IRCCS Ca’ Granda Policlinico, Department of Pathophysiology and Transplant, University of Milan, Milan, Italy
                [ ]Bipolar Disorders Clinic, Stanford Medical School, Palo Alto, CA USA
                [ ]Italian Association for Metals and Biocompatibility Research-A.I.R.M.E.B., (not-for-profit organization), Via A. Banfi, 4, 20122 Milan, Italy
                Article
                Publisher ID: 44
                DOI: 10.1186/s40345-015-0044-y
                PMC ID: 4709333
                PubMed ID: 26753697
                SO-VID: 515dd940-27e6-4d14-b985-9920a0d8cd5e
                Copyright © © Pigatto et al. 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 14 December 2015
                Date accepted : 23 December 2015
                Categories
                Subject: Letter to the Editor
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

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