Table 5.
Lithium intoxication – case series with a sample size >50 reporting outcome in the literature after the year 2000.
| Author, publication year, country | Type of study, length | Sample/incidence | Male: female ratio, age | Symptoms | Risk factors | Overdoses (OD) %, mean lithium, mmol/L, (range) | HD, ICU | Fatalities |
|---|---|---|---|---|---|---|---|---|
| Bretaudeau Deguigne et al., 2013, France | Retrospective, 4.7 years | Poison control centre, 59 patients with lithium intoxication undergoing early digestive tract decontamination. | 1:3 | GI symptoms 69% somnolence/coma 51% tremor 24% hypertonia 8% ECG signs 31% CV symptoms 8% confusion/agitation 29% myoclonus 17% convulsions 8% acute renal failure 22% diabetes insipidus 5% aspiration pneumonia 3% |
100% | ICU 49% HD 19% |
None | |
| Lopez et al., 2012, Spain | Retrospective, 4.25 years | Hospital admission data, 65 patients with lithium intoxication, 14 patients with HD analysed | 1:1 | neurological signs 78.5% leukocytosis 85.7% Art. hypotension 57.1% GI symptoms 35.7% renal failure 64.3% |
OD 71.4% (10/14) | 23% ICU (15/65) 22% HD (14/65) | None | |
| Dennison et al., 2011, Ireland | Retrospective, 5 years | Laboratory data. 130 cases of lithium toxicity with lithium levels >1.5 mmol/L referred to hospital. 47 cases reviewed. Incidence 5.4/100,000 population/year. |
1: 1.7, 55 years (19–86) | Confusion 44.7%; drowsiness 36.2%; altered arousal 21.3%; fatigue 26%; lethargy: 23% slurred speech 19.1%; tremor 51%; ataxia 38%; seizure 4.3%; anorexia 30%; nausea/diarrhoea 28% |
Diuretics 21.3%; NSAID 4.2% |
OD 25.5% 2.16 mmol/L (1.5–6.7) |
HD 11%, ICU 2.1% |
None |
| Offerman et al., 2010, USA | Retrospective, 5 years | Poison control system. 629 cases of lithium toxicity resulting in hospital admission reported. 502 cases included. |
1:1.9, 48 years (20–84) | Altered level of consciousness 69.3%, more common in chronic exposures; tremor 37.1%; GI symptoms 18.6%; CV complications 5.7% seizures 3.0% |
OD 33.5% mean 2.92 mmol/L (0.5–7.0) | HD 11.0% | 4 (0.8%), 3 not related to lithium, one bradycardic arrest | |
| Juurlink et al., 2004, Canada | Retrospective, 10 years | Prescription data. 413/10,615 (3.9%) patients ⩾66 years treated with lithium admitted to hospital at least once for lithium toxicity. Lithium intoxication diagnosed as lithium exposure+ICD-9 code 985.9 or 969.8. |
1:1.9, 72 years (66–) | Not given in detail | ACEH 3.4%; loop diuretics 2.9%, thiazides 1.2%; NSAID 1.0% |
HD 3%, ICU 15% |
19 (5%) unclear reasons |
|
| Chen et al., 2004, Taiwan | Retrospective, 3.5 years | Laboratory data. 78 patients with excessive lithium levels ⩾1.2 mmol/L identified by a psychiatric centre. 38 patients ⩾1.5 mmol/L |
1:1.7, 44 years (15–76) | Not given in detail | OD 55.1%. Lithium level range 1.2–3.1 mmol/L | HD 1% | None | |
| de Haro et al., 2003, France | Retrospective, 10 years | Poison centre. 304 cases reported. |
1:2.1, 1–85, 13 children | For intentional OD (n=190): Somnolence 76%; disorientation 11%; coma 5% tremor 16% hypertension 21%; CV complications 8%; vomiting 8% |
Loop diuretics 2.6%; renal impairment 4.9%; dehydration 11.5% |
OD 62.5%. Lithium level range 0.2–12 mmol/L | HD 5% | 6 (2%) seizures, ventricular fibrillation, hypotension |
| Montagnon et al., 2002, France | Retrospective, 8 years | Hospital admission data, 81 cases treated in toxicological intensive care | Men<women | Unclear: ‘most patients were admitted with grade 1 coma’ | Renal insufficiency 9.8%; Acute pyelonephritis 2.5%; Interaction between alactazine and captopril 2.5%, poor medication compliance 2.5%; drunkenness 2.5% nephrogenic diabetes insipidus 1.2% |
77.8% OD | ICU 100% HD 3–6% |
3 (3.7%) |
| Webb et al., 2001, USA | Prospective, 7 years | Drug use evaluation programme. 151 (6.8%) of 2210 patients on lithium admitted to hospital with Li ⩾1.5. | 1:1.7, 45 years | Symptoms 28% ataxia 15.8% lethargia 9.9% delirium 4.0% polydipsia 4.0% vomiting 3.3% tremor 2.0% |
Diuretics 6% ACEI 2.6% renal impairment 6.6% |
None | ||
| Bailey and McGuigan, 2000, Canada | Prospective, 1 year | Poison information centre. 205 cases reported. 110 cases >1.5 mmol/L | 1:2.0, 11–94 years | Drowsiness 32%; confusion 4%; stupor/obtunded 3% coma 4%; slurred speech 13%; tremor 12% hyperreflexia 4% rigidity: <1% seizures: <1%; CV complications 12%; GI symptoms 8% |
Renal impairment 12.1% | Lithium level range 0–8.9 mmol/L | 4% | 2: one in renal failure, one after pulmonary aspiration under HD |
HD: haemodialysis; GI: gastrointestinal; CV: cardiovascular.