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Management of Lithium Toxicity

  • Review Article
  • Published:
Toxicological Reviews

Abstract

Lithium salts have been used in the prophylaxis and treatment of depression and bipolar disorder for >50 years. Lithium has a narrow therapeutic range, and several well characterised adverse effects limit the potential usefulness of higher doses. Acute ingestion in lithium-naive patients is generally associated with only short-lived exposure to high concentrations, due to extensive distribution of lithium throughout the total body water compartment. Conversely, chronic toxicity and acute-on-therapeutic ingestion are associated with prolonged exposure to higher tissue concentrations and, therefore, greater toxicity. Lithium toxicity may be life threatening, or result in persistent cognitive and neurological impairment. Therefore, enhanced lithium clearance has been explored as a means of minimising exposure to high tissue concentrations. Although haemodialysis is highly effective in removing circulating lithium, serum concentrations often rebound so repeated or prolonged treatment may be required. Continuous arteriovenous haemodiafiltration and continuous venovenous haemodiafiltration increase lithium clearance, albeit to a lesser extent than haemodialysis, and are more widely accessible. Haemodiafiltration sustained for >16 hours allows effective removal of total body lithium, thereby avoiding rebound effects. Enhanced elimination should be considered in patients at greatest risk of severe poisoning: namely those with chronic or acute-on-therapeutic toxicity, those with clinically significant features, and those with chronic toxicity whose serum lithium concentration is >2.5 mmol/L. The choice between haemodialysis and continuous haemodiafiltration techniques will depend on local accessibility and urgency of enhancing lithium elimination. Further research is required to establish the potential benefits of assisted elimination on clinical outcome in patients with lithium poisoning.

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References

  1. Parkinson J. Observations on the nature and cure of gout, on the nodes of joints, and on the influence of certain articles of diet in gout, rheumatism, and gravel. London: Symonds, 1805

    Google Scholar 

  2. Haig A. Uric acid as a factor in the causation of disease: a contribution to the pathology of high arterial tension, headache, epilepsy, mental depression, gout, Bright’s disease, and other disorders. 2nd ed. London: P. Blakiston, 1894

    Google Scholar 

  3. El-Mallakh RS, Jefferson JW. Prethymoleptic use of lithium. Am J Psychiatry 1999; 156: 129

    PubMed  CAS  Google Scholar 

  4. Garrod AB. A treatise on gout and rheumatic gout. London: Longman, 1876

    Google Scholar 

  5. Strobusch AD, Jefferson JW. The checkered history of lithium in medicine. Pharm Hist 1980; 22: 72–6

    PubMed  CAS  Google Scholar 

  6. Cade JFJ. Lithium salts in the treatment of psychotic excitement. Med J Aust 1949; 36: 349–52

    Google Scholar 

  7. Lenox RH, Hahn CG. Overview of the mechanism of action of lithium in the brain: fifty-year update. J Clin Psychiatry 2000; 61Suppl. 9: 5–15

    PubMed  CAS  Google Scholar 

  8. Sproule B. Lithium in bipolar disorder: can drug concentrations predict therapeutic effect? Clin Pharmacokinet 2002; 41: 639–60

    Article  PubMed  Google Scholar 

  9. Jackson BA, Edwards RM, Dousa TP. Lithium-induced polyuria: effect of lithium on adenylate cyclase and adenosine 3′,5′-monophosphate phosphodiesterase in medullary ascending limb of Henle’s loop and in medullary collecting tubules. Endocrinology 1980; 107: 1693–8

    Article  PubMed  CAS  Google Scholar 

  10. DePaulo JR, Correa EI, Sapir DG. Renal toxicity of lithium and its implications. Johns Hopkins Med J 1981; 149: 15–21

    PubMed  CAS  Google Scholar 

  11. Presne C, Fakhouri F, Noel LH, et al. Lithium-induced nephropathy: rate of progression and prognostic factors. Kidney Int 2003; 64: 585–92

    Article  PubMed  CAS  Google Scholar 

  12. Turan T, Esel E, Tokgoz B, et al. Effects of short- and long-term lithium treatment on kidney functioning in patients with bipolar mood disorder. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 561–5

    Article  PubMed  CAS  Google Scholar 

  13. Boton R, Gaviria M, Batlle DC. Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. Am J Kidney Dis 1987; 10: 329–45

    PubMed  CAS  Google Scholar 

  14. Markowitz GS, Radhakrishnan J, Kambham N, et al. Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy. J Am Soc Nephrol 2000; 11: 1439–48

    PubMed  CAS  Google Scholar 

  15. Peet M, Pratt JP. Lithium. Current status in psychiatric disorders. Drugs 1993; 46: 7–17

    Article  PubMed  CAS  Google Scholar 

  16. Okusa MD, Crystal LJ. Clinical manifestations and management of acute lithium intoxication. Am J Med 1994; 97: 383–9

    Article  PubMed  CAS  Google Scholar 

  17. Otto W, Paalzow L, Suren G. Lithium absorption from ordinary and sustained-release tablets. Acta Pharm Suec 1972; 9: 595–601

    PubMed  CAS  Google Scholar 

  18. Kirkwood CK, Wilson SK, Hayes PE, et al. Single-dose bioavailability of two extended-release lithium carbonate products. Am J Hosp Pharm 1994; 51: 486–9

    PubMed  CAS  Google Scholar 

  19. Achong MR, Fernandez PG, McLeod PJ. Fatal self-poisoning with lithium carbonate. CMAJ 1975; 112: 868–70

    CAS  Google Scholar 

  20. Jensen H, Ladefoged J. Delayed absorption of lithium in intoxication: a case history. Eur J Clin Pharmacol 1975; 8: 285

    Article  PubMed  CAS  Google Scholar 

  21. Marshall SM, Kesson CM. Severe lithium poisoning. Drug Intell Clin Pharm 1981; 15: 598–9

    PubMed  CAS  Google Scholar 

  22. Dupuis RE, Cooper AA, Rosamond LJ, et al. Multiple delayed peak lithium concentrations following acute intoxication with an extended-release product. Ann Pharmacother 1996; 30: 356–60

    PubMed  CAS  Google Scholar 

  23. Jaeger A, Sauder P, Kopferschmitt J, et al. When should dialysis be performed in lithium poisoning: a kinetic study in 14 cases of lithium poisoning. J Toxicol Clin Toxicol 1993; 31: 429–47

    Article  PubMed  CAS  Google Scholar 

  24. Waring WS, Webb DJ, Maxwell SR. Lithium carbonate as a potential pharmacological vehicle: intravenous kinetics of single-dose administration in healthy subjects. Eur J Clin Pharmacol 2002; 58: 431–4

    Article  PubMed  CAS  Google Scholar 

  25. Swann AC, Berman N, Frazer A, et al. Lithium distribution in mania: single-dose pharmacokinetics and sympathoadrenal function. Psychiatry Res 1990; 32: 71–84

    Article  PubMed  CAS  Google Scholar 

  26. Friedberg RC, Spyker DA, Herold DA. Massive overdoses with sustained-release lithium carbonate preparations: pharmacokinetic model based on two case studies. Clin Chem 1991; 37: 1205–9

    PubMed  CAS  Google Scholar 

  27. Finley PR, Warner MD, Peabody CA. Clinical relevance of drug interactions with lithium. Clin Pharmacokinet 1995; 29: 172–91

    Article  PubMed  CAS  Google Scholar 

  28. Schou M. Lithium studies, III: distribution between serum and tissues. Acta Pharmacol Toxicol 1958; 15: 115–24

    Article  CAS  Google Scholar 

  29. Rey AC, Jimerson DC, Post RM. Lithium and electrolytes in cerebrospinal fluid of affectively ill patients during acute and chronic lithium treatment. Commun Psychopharmacol 1979; 3: 267–78

    PubMed  CAS  Google Scholar 

  30. White K, Cohen J, Boyd J, et al. Relationship between plasma, RBC, and CSF lithium concentrations in human subjects. Int Pharmacopsychiatry 1979; 14: 185–9

    PubMed  CAS  Google Scholar 

  31. Jaeger A, Sauder P, Kopferschmitt J, et al. Toxicokinetics of lithium intoxication treated by hemodialysis. J Toxicol Clin Toxicol 1985; 23: 501–17

    Article  PubMed  Google Scholar 

  32. Mallinger AG, Frank E, Thase ME, et al. Low rate of membrane lithium transport during treatmentcorrelates with outcome of maintenance pharmacotherapy in bipolar disorder. Neuropsychopharmacology 1997; 16: 325–32

    Article  PubMed  CAS  Google Scholar 

  33. Hitzemann R, Mark C, Hirschowitz J, et al. RBC lithium transport in the psychoses. Biol Psychiatry 1989; 25: 296–304

    Article  PubMed  CAS  Google Scholar 

  34. Gengo F, Frazer A, Ramsey TA, et al. The lithium ratio as a guide to patient compliance. Compr Psychiatry 1980; 21: 276–80

    Article  PubMed  CAS  Google Scholar 

  35. Soares JC, Boada F, Spencer S, et al. Brain lithium concentrations in bipolar disorder patients: preliminary (7)Li magnetic resonance studies at 3 T. Biol Psychiatry 2001; 49: 437–43

    Article  PubMed  CAS  Google Scholar 

  36. Komoroski RA, Newton JE, Sprigg JR, et al. In vivo 7Li nuclear magnetic resonance study of lithium pharmacokinetics and chemical shift imaging in psychiatric patients. Psychiatry Res 1993; 50: 67–76

    Article  PubMed  CAS  Google Scholar 

  37. Kato T, Shioiri T, Inubushi T, et al. Brain lithium concentrations measured with lithium-7 magnetic resonance spectroscopy in patients with affective disorders: relationship to erythrocyte and serum concentrations. Biol Psychiatry 1993; 33: 147–52

    Article  PubMed  CAS  Google Scholar 

  38. Mason RW, McQueen EG, Keary PJ, et al. Pharmacokinetics of lithium: elimination half-time, renal clearance and apparent volume of distribution in schizophrenia. Clin Pharmacokinet 1978; 3: 241–6

    Article  PubMed  CAS  Google Scholar 

  39. Koomans HA, Boer WH, Dorhout Mees EJ. Evaluation of lithium clearance as a marker of proximal tubule sodium handling. Kidney Int 1989; 36: 2–12

    Article  PubMed  CAS  Google Scholar 

  40. Thomsen K, Schou M. Renal lithium excretion in man. Am J Physiol 1968, 7

    Google Scholar 

  41. Bosse GM, Arnold TC. Overdose with sustained-release lithium preparations. J Emerg Med 1992; 10: 719–21

    Article  PubMed  CAS  Google Scholar 

  42. Bailey B, McGuigan M. Comparison of patients hemodialyzed for lithium poisoning and those for whom dialysis was recommended by PCC but not done: what lesson can we learn? Clin Nephrol 2000; 54: 388–92

    PubMed  CAS  Google Scholar 

  43. Dyson EH, Simpson D, Prescott LF, et al. Self-poisoning and therapeutic intoxication with lithium. Hum Toxicol 1987; 6: 325–9

    Article  PubMed  CAS  Google Scholar 

  44. Ferron G, Debray M, Buneaux F, et al. Pharmacokinetics of lithium in plasma and red blood cells in acute and chronic intoxicated patients. Int J Clin Pharmacol Ther 1995; 33: 351–5

    PubMed  CAS  Google Scholar 

  45. Parfitt K, editor. Martindale: the complete drug reference. 35th ed. London: Pharmaceutical Press, 2006

    Google Scholar 

  46. Goddard J, Bloom SR, Frackowiak RS, et al. Lithium intoxication. BMJ 1991; 302: 1267–9

    Article  PubMed  CAS  Google Scholar 

  47. Thiel A, Nau R, Lehmann K, et al. Intoxication in manic patients following chaotic self-administration of lithium. Acta Psychiatr Scand 1993; 88: 289–91

    Article  PubMed  CAS  Google Scholar 

  48. Chang YC, Yip PK, Chiu YN, et al. Severe generalized polyneuropathy in lithium intoxication. Eur Neurol 1988; 28: 39–41

    Article  PubMed  CAS  Google Scholar 

  49. Podskalny GD, Factor SA. Chorea caused by lithium intoxication: a case report and literature review. Mov Disord 1996; 11: 733–7

    Article  PubMed  CAS  Google Scholar 

  50. Bartha L, Marksteiner J, Bauer G, et al. Persistent cognitive deficits associated with lithium intoxication: a neuropsychological case description. Cortex 2002; 38: 743–52

    Article  PubMed  Google Scholar 

  51. Singh SV. Lithium carbonate/fluphenazine decanoate producing irreversible brain damage. Lancet 1982; II: 278

    Article  Google Scholar 

  52. West AP. Lithium-induced neurotoxicity and irreversible brain damage: a possible mechanism and antidote. J Clin Psychiatry 1985; 46: 300

    PubMed  CAS  Google Scholar 

  53. Apte SN, Langston JW. Permanent neurological deficits due to lithium toxicity. Ann Neurol 1983; 13: 453–5

    Article  PubMed  CAS  Google Scholar 

  54. Nagaraja D, Taly AB, Sahu RN, et al. Permanent neurological sequelae due to lithium toxicity. Clin Neurol Neurosurg 1987; 89: 31–4

    Article  PubMed  CAS  Google Scholar 

  55. Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28: 38–49

    Article  PubMed  CAS  Google Scholar 

  56. Schneider JA, Mirra SS. Neuropathologic correlates of persistent neurologic deficit in lithium intoxication. Ann Neurol 1994; 36: 928–31

    Article  PubMed  CAS  Google Scholar 

  57. Naramoto A, Koizumi N, Itoh N, et al. An autopsy case of cerebellar degeneration following lithium intoxication with neuroleptic malignant syndrome. Acta Pathol Jpn 1993; 43: 55–8

    PubMed  CAS  Google Scholar 

  58. Peiffer J. Clinical and neuropathological aspects of long-term damage to the central nervous system after lithium medication. Arch Psychiatr Nervenkr 1981; 231: 41–60

    Article  PubMed  CAS  Google Scholar 

  59. Mangano WE, Montine TJ, Hulette CM. Pathologic assessment of cerebellar atrophy following acute lithium intoxication. Clin Neuropathol 1997; 16: 30–3

    PubMed  CAS  Google Scholar 

  60. Clendeninn NJ, Pond SM, Kaysen G, et al. Potential pitfalls in the evaluation of the usefulness of hemodialysis for the removal of lithium. J Toxicol Clin Toxicol 1982; 19: 341–52

    Article  PubMed  CAS  Google Scholar 

  61. Tilkian AG, Schroeder JS, Kao JJ, et al. The cardiovascular effects of lithium in man: a review of the literature. Am J Med 1976; 61: 665–70

    Article  PubMed  CAS  Google Scholar 

  62. Mitchell JE, Mackenzie TB. Cardiac effects of lithium therapy in man: a review. J Clin Psychiatry 1982; 43: 47–51

    PubMed  CAS  Google Scholar 

  63. Mateer JR, Clark MR. Lithium toxicity with rarely reported ECG manifestations. Ann Emerg Med 1982; 11: 208–11

    Article  PubMed  CAS  Google Scholar 

  64. Waring WS. Delayed cardiotoxicity in chronic lithium poisoning: discrepancy between serum lithium concentrations and clinical status. Basic Clin Pharmacol Toxicol. In press

  65. Fenves AZ, Emmett M, White MG. Lithium intoxication associated with acute renal failure. South Med J 1984; 77: 1472–4

    Article  PubMed  CAS  Google Scholar 

  66. Flaherty B, Krenzelok EP. Neonatal lithium toxicity as a result of maternal toxicity. Vet Hum Toxicol 1997; 39: 92–3

    PubMed  CAS  Google Scholar 

  67. Waring WS, Good AM, Bateman DN. Acute lithium toxicity is commonly reported as a mixed overdose: prospective evaluation of enquiries to a regional poisons centre. Clin Toxicol 2004; 42: 529–30

    Google Scholar 

  68. Horowitz LC, Fisher GU. Acute lithium toxicity. N Engl J Med 1969; 281: 1369

    PubMed  CAS  Google Scholar 

  69. Kondziela JR. Extreme lithium intoxication without severe symptoms. Hosp Community Psychiatry 1984; 35: 727–8

    PubMed  CAS  Google Scholar 

  70. Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Aust N Z J Psychiatry 2001; 35: 833–40

    Article  PubMed  CAS  Google Scholar 

  71. Hansen HE, Amdisen A. Lithium intoxication: report of 23 cases and review of 100 cases from the literature. Q J Med 1978; 47: 123–44

    PubMed  CAS  Google Scholar 

  72. Position paper: Ipecac syrup. J Toxicol Clin Toxicol 2004; 42: 133–43

  73. Thornley-Brown D, Galla JH, Williams PD, et al. Lithium toxicity associated with a trichobezoar. Ann Intern Med 1992; 116: 739–40

    PubMed  CAS  Google Scholar 

  74. Teece S, Crawford I. Best evidence topic report: no clinical evidence for gastric lavage in lithium overdose. Emerg Med J 2005; 22: 43–4

    Article  PubMed  Google Scholar 

  75. Smith SW, Ling LJ, Halstenson CE. Whole-bowel irrigation as a treatment for acute lithium overdose. Ann Emerg Med 1991; 20: 536–9

    Article  PubMed  CAS  Google Scholar 

  76. Position paper: whole bowel irrigation. J Toxicol Clin Toxicol 2004; 42: 843–54

    Google Scholar 

  77. Favin FD, Klein-Schwartz W, Oderda GM, et al. In vitro study of lithium carbonate adsorption by activated charcoal. J Toxicol Clin Toxicol 1988; 26: 443–50

    Article  PubMed  CAS  Google Scholar 

  78. Watling SM, Gehrke JC, Gehrke CW, et al. In vitro binding of lithium using the cation exchange resin sodium polystyrene sulfonate. Am J Emerg Med 1995; 13: 294–6

    Article  PubMed  CAS  Google Scholar 

  79. Linakis JG, Lacouture PG, Eisenberg MS, et al. Administration of activated charcoal or sodium polystyrene sulfonate (Kayexalate) as gastric decontamination for lithium intoxication: an animal model. Pharmacol Toxicol 1989; 65: 387–9

    Article  PubMed  CAS  Google Scholar 

  80. Linakis JG, Eisenberg MS, Lacouture PG, et al. Multiple-dose sodium polystyrene sulfonate in lithium intoxication: an animal model. Pharmacol Toxicol 1992; 70: 38–40

    Article  PubMed  CAS  Google Scholar 

  81. Linakis JG, Hull KM, Lacouture PG, et al. Enhancement of lithium elimination by multiple-dose sodium polystyrene sulfonate. Acad Emerg Med 1997; 4: 175–8

    Article  PubMed  CAS  Google Scholar 

  82. Belanger DR, Tierney MG, Dickinson G. Effect of sodium polystyrene sulfonate on lithium bioavailability. Ann Emerg Med 1992; 21: 1312–5

    Article  PubMed  CAS  Google Scholar 

  83. Gehrke JC, Watling SM, Gehrke CW, et al. In-vivo binding of lithium using the cation exchange resin sodium polystyrene sulfonate. Am J Emerg Med 1996; 14: 37–8

    Article  PubMed  CAS  Google Scholar 

  84. Tomaszewski C, Musso C, Pearson JR, et al. Lithium absorption prevented by sodium polystyrene sulfonate in volunteers. Ann Emerg Med 1992; 21:1308–11

    Article  PubMed  CAS  Google Scholar 

  85. Roberge RJ, Martin TG, Schneider SM. Use of sodium polystyrene sulfonate in a lithium overdose. Ann Emerg Med 1993; 22: 1911–5

    Article  PubMed  CAS  Google Scholar 

  86. Meredith TJ, Vale JA. Treatment of paraquat poisoning in man: methods to prevent absorption. Hum Toxicol 1987; 6: 49–55

    Article  PubMed  CAS  Google Scholar 

  87. Ponampalam R, Otten EJ. In vitro adsorption of lithium by bentonite. Singapore Med J 2002; 43: 86–9

    CAS  Google Scholar 

  88. Colussi G, Rombola G, Surian M, et al. Effects of acute administration of acetazolamide and frusemide on lithium clearance in humans. Nephrol Dial Transplant 1989; 4: 707–12

    PubMed  CAS  Google Scholar 

  89. Atherton JC, Green R, Higgins A, et al. Lithium clearance in healthy humans: effects of sodium intake and diuretics. Kidney Int Suppl 1990; 28: S36–8

    PubMed  CAS  Google Scholar 

  90. Parfrey PS, Ikeman R, Anglin D, et al. Severe lithium intoxication treated by forced diuresis. CMAJ 1983; 129: 979–80

    CAS  Google Scholar 

  91. Forrest JAH. Forced alkaline diuresis for lithium intoxication. Postgrad Med J 1975; 51: 189–91

    Article  Google Scholar 

  92. Amdisen A. Serum level monitoring and clinical pharmacokinetics of lithium. Clin Pharmacokinet 1977; 2: 73–92

    Article  PubMed  CAS  Google Scholar 

  93. Jacobsen D, Aasen G, Frederichsen P, et al. Lithium intoxication: pharmacokinetics during and after terminated hemodialysis in acute intoxications. J Toxicol Clin Toxicol 1987; 25: 81–94

    Article  PubMed  CAS  Google Scholar 

  94. Eyer F, Pfab R, Felgenhauer N, et al. Lithium poisoning: pharmacokinetics and clearance during different therapeutic measures. J Clin Psychopharmacol 2006; 26: 325–30

    Article  PubMed  CAS  Google Scholar 

  95. Macdonald TM, Cotton M, Prescott LF. Low dose dopamine in lithium poisoning. Br J Clin Pharmacol 1988; 26: 195–7

    Article  PubMed  CAS  Google Scholar 

  96. Amdisen A. Clinical features and management of lithium poisoning. Med Toxicol Adverse Drug Exp 1988; 3: 18–32

    Article  PubMed  CAS  Google Scholar 

  97. Szerlip HM, Heeger P, Feldman GM. Comparison between acetate and bicarbonate dialysis for the treatment of lithium intoxication. Am J Nephrol 1992; 12: 116–20

    Article  PubMed  CAS  Google Scholar 

  98. Perrier A, Martin PY, Favre H, et al. Very severe self-poisoning lithium carbonate intoxication causing a myocardial infarction. Chest 1991; 100: 863–5

    Article  PubMed  CAS  Google Scholar 

  99. Swartz CM, Jones P. Hyperlithemia correction and persistent delirium. J Clin Pharmacol 1994; 34: 865–70

    PubMed  CAS  Google Scholar 

  100. Swartz CM, Dolinar LJ. Encephalopathy associated with rapid decrease of high levels of lithium. Ann Clin Psychiatry 1995; 7: 207–9

    Article  PubMed  CAS  Google Scholar 

  101. Swartz CM. Central pontine myelinolysis and lithium toxicity. Ann Clin Psychiatry 2003; 15:133

    PubMed  Google Scholar 

  102. Swartz CM. A case for gradual reduction of high lithium levels. Psychosomatics 1994; 35: 411–2

    Article  PubMed  CAS  Google Scholar 

  103. Bismuth C, Baud FJ, Buneaux F, et al. Spontaneous toxicokinetics of lithium during a therapeutic overdose with renal failure. J Toxicol Clin Toxicol 1986; 24: 261–8

    Article  PubMed  CAS  Google Scholar 

  104. Geronemus R, Schneider N. Continuous arteriovenous hemodialysis: a new modality for treatment of acute renal failure. Trans Am Soc Artif Intern Organs 1984; 30: 610–3

    PubMed  CAS  Google Scholar 

  105. Bellomo R, Kearly Y, Parkin G, et al. Treatment of life-threatening lithium toxicity with continuous arterio-venous hemodiafiltration. Crit Care Med 1991; 19: 836–7

    Article  PubMed  CAS  Google Scholar 

  106. Maggiore Q, Pizzarelli F, Dattolo P, et al. Cardiovascular stability during haemodialysis, haemofiltration and haemodiafiltration. Nephrol Dial Transplant 2000; 15Suppl. 1: 68–73

    Article  PubMed  Google Scholar 

  107. van Bommel EF, Kalmeijer MD, Ponssen HH. Treatment of life-threatening lithium toxicity with high-volume continuous venovenous hemofiltration. Am J Nephrol 2000; 20: 408–11

    Article  PubMed  Google Scholar 

  108. Leblanc M, Raymond M, Bonnardeaux A, et al. Lithium poisoning treated by high-performance continuous arteriovenous and venovenous hemodiafiltration. Am J Kidney Dis 1996; 27: 365–72

    Article  PubMed  CAS  Google Scholar 

  109. Brown EA, Pawlikowski TRB. Lithium intoxication treated by peritoneal dialysis. Br J Clin Pract 1981; 35: 90–1

    PubMed  CAS  Google Scholar 

  110. Wilson JHP, Donker AJM, van der Hem GK, et al. Peritoneal dialysis for lithium poisoning. BMJ 1971; 2: 749–50

    Article  PubMed  CAS  Google Scholar 

  111. Bailey B, McGuigan M. Lithium poisoning from a poison control center perspective. Ther Drug Monit 2000; 22: 650–5

    Article  PubMed  CAS  Google Scholar 

  112. Hauger RL, O’Connor KA, Yudofsky S, et al. Lithium toxicity: when is hemodialysis necessary? Acta Psychiatr Scand 1990; 81: 515–7

    Article  PubMed  CAS  Google Scholar 

  113. Simard M, Gumbiner B, Lee A, et al. Lithium carbonate intoxication: a case report and review of the literature. Arch Intern Med 1989; 149: 36–46

    Article  PubMed  CAS  Google Scholar 

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No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the contents of this review.

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  1. Royal Infirmary of Edinburgh, Scottish Poisons Information Bureau, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    W. Stephen Waring

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Waring, W.S. Management of Lithium Toxicity. Toxicol Rev 25, 221–230 (2006). https://doi.org/10.2165/00139709-200625040-00003

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