Lithium toxicity profile a systematic review and meta analysis pdf

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lithium toxicity profile a systematic review and meta analysis pdf

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Lithium Toxicity in the Setting of Nonsteroidal Anti-Inflammatory Medications

Lithium is an effective first-line mood stabiliser for bipolar disorder, treatment-refractory depression and suicide prevention. Studies have demonstrated its ability to produce neuroprotective benefits. Despite this, Lithium can cause neurotoxicity, cardiotoxicity and endocrine derangement resulting in severe and potentially permanent side effects. Lithium toxicity can be precipitated by illness, salt restriction diets, dehydration, nephrogenic diabetes insipidus, impaired creatinine clearance, concomitant drugs. This is particularly true in older patients with altered pharmacodynamics and pharmacokinetics.

Lithium toxicity profile: a systematic review and meta-analysis

Despite its efficacy, lithium has a narrow therapeutic index and adverse effects are frequent. Lithium intoxication LI generally affects brain, but less frequently can affect kidneys, thyroid, and parathyroid. Here, we report the case of a patient with lithium neurotoxic effects complicated by parathyroid and renal adverse effects. The patient was a year-old woman treated with lithium, who was recently diagnosed with hypercalcemia and hyperparathyroidism. She was admitted for severe agitation, confusion, and diffuse tremor. Despite serum lithium and calcium normalization, laboratory tests revealed a life-threatening hypernatremia caused by nephrogenic diabetes insipidus NDI. Hemodialysis was started, but after the first treatment the patient died for cardiac arrest.

Background: Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects. We aimed to undertake a clinically informative, systematic toxicity profile of lithium. Methods: We undertook a systematic review and meta-analysis of randomised controlled trials and observational studies. We searched electronic databases, specialist journals, reference lists, textbooks, and conference abstracts. We used a hierarchy of evidence which considered randomised controlled trials, cohort studies, case-control studies, and case reports that included patients with mood disorders given lithium. Outcome measures were renal, thyroid, and parathyroid function; weight change; skin disorders; hair disorders; and teratogenicity.

Lithium Treatment Over the Lifespan in Bipolar Disorders

Metrics details. A recent paper by McKnight et al. The authors analyzed studies and focused mainly on the harmful effects of lithium on the kidney, the thyroid and parathyroid glands, body weight, skin and congenital malformations. Their contribution is important and welcome, but as a guide for practice, it needs to be complemented by other relevant observations and individual patient-focused perspectives. The findings from that meta-analysis somewhat underestimate the renal side-effects, and distort to some degree or exclude other adverse effects.

Lithium toxicity profile: a systematic review and meta-analysis

Commentary on a recent review of lithium toxicity: what are its implications for clinical practice?

This study encompasses a broad critical review on the safety and tolerability of lithium for mood disorders. The final selection yielded 91 studies. Lithium users showed a high prevalence of hypothyroidism, hyperparathyroidism, and decrease in urinary concentration ability. Reduction of glomerular filtration rate in patients using lithium was also observed, but in a lesser extent. The evidence of teratogenicity associated with lithium use is not well established.

Lithium has been the treatment of choice for patients with bipolar disorder BD for nearly 70 years. It is recommended by all relevant guidelines as a first-line treatment for maintenance therapy. In this review, we outline the current state of evidence for lithium in the treatment of BD over the lifespan. First, we summarize the evidence on efficacy in general, from relapse prevention to acute anti-manic treatment and its role in treating mood episodes with mixed features and bipolar depression. As patients are often treated for many years and different aspects have to be considered in different phases of life, we discuss the particularities of lithium in the treatment of paediatric BD, in older aged individuals and in pregnant women. Lastly, we discuss the evidence on lithium's proposed suicide-preventive effects, the dangers of rapid discontinuation and lithium's adverse effects, particularly with regard to long-term treatment.

Commentary on a recent review of lithium toxicity: what are its implications for clinical practice?