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Mégarbane B, Baud F
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Do we have to clear plasma or cells from toxicant? A lesson from lithium poisoning. | Title |
XXII International Congress of the EAPCCT, Lisbon, Portugal, 22-25 May, 2002. Abstract in: J Toxicol Clin Toxicol 2002, 40(3), 313-314
| Source |
| Lithium, Therapy
| Index terms |
| Objectives: Enhancement of toxicant elimination is a classical conventional method proposed in acute
poisonings. Lithium (Li) poisoning can generate severe and prolonged neurological complications, due to central nervous system. Extra-renal elimination methods may enhance Li elimination; however, to date, no randomized study proved clearly their benefit for making clinical signs regress. The objectives of this study were to analyze the dialysis criteria used by the physicians in charge of the poisoned patients and to evaluate its possible benefits and effects on Li kinetics.
Methods: Retrospective data collection of patients admitted to our intensive care unit (ICU), from 19922000 for acute intentional self-poisonings or therapeutic overdoses; descriptive analysis (median, extremes); Li kinetic study (Kinetica® Software); subgroup comparisons using Chi2 and MannWhitney tests; multivariate analysis with logistic regression and odds-ratio determination.
Results: Forty-eight patients were included: 14M/34F, age: 47 years [2178], SAPS II score: 29 [6102]‹acute self-poisoning (10%), acute intoxication upon chronic Li therapy (63%) and therapeutic overdose (27%)‹stage I (38%), II (31%) and III (31%) of the Hansen and
Amdisen classification. On admission, 46% had a Glasgow Coma Score = 12, 8% were shocked and 33% were mechanically ventilated. The median plasma Li concentration was 2.82 mEq/L [0.4610.0] on admission and increased to 3.02 mEq/L [0.5512.40]. 5/48 patients (10%) were dialyzed (2 with hemodialysis and 3 with continuous veno-venous hemodiafiltration). The median length of ICU stay was 5 days [1 40]. 2/48 patients (4%) died. The median plasma Li peak was significantly different according to the poisoning type ( p = 0.01). The supposed ingested dose ( p = 0.04), the delay between admission and ingestion ( p = 0.004) and the plasma creatinine
concentration on admission ( p = 0.004) were significantly different between the subgroups of patients according to their plasma Li level (< or = 3 mEq/L). There was a significant decrease in plasma elimination half-life following dialysis. Subgroup comparison according to dialysis shows the results in Table 1 (omitted in ToxiLit). By a multivariate analysis, only a plasma Li maximal concentration = 3 mEq/L was predictive of dialysis requirement (OR = 5.6).
Conclusion: Dialysis is not a priority in the management of Li poisoning. Indications are based on clinical (worsening of neurological signs and renal failure), and kinetic criteria (poisoning profile
and plasma Li concentration). Clearing plasma from Li is not a guarantee to obtain any favorable clinical results. The brainblood barrier contributes to the separation of Li biophase from blood compartment, rendering the efficacy of Li plasma instead of cells clearing very illusive.
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| Disclaimer: The producers of these references take care to avoid errors but cannot be hold responsible for inaccuracies. Also, knowledge is constantly changing and the reader is advised to search carefully for the most recent and relevant studies.
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