Lithium is recommended as a first-line maintenance treatment for bipolar disorder and treatment-refractory depression. While long-term lithium use is associated with an increased risk of loss of renal function and chronic kidney disease, little is known about the incidence, clinical course, and associated factors of acute lithium toxicity.
To determine the frequency of lithium intoxication and the risk for lithium-associated renal dysfunction, a team of Swedish researchers analyzed medical data of 1,340 adult patients who had been exposed to lithium between 1997 and 2013. The authors first calculated the episodes per patient treated over the entire 17-year observation period. Then, they estimated the incidence of lithium intoxication per treatment year based on lithium prescribing data from the Swedish National Board of Health and Welfare.
Of 1,340 patients, 96 (7.16%) had experienced at least one episode of lithium levels equal to or greater than 1.5 mmol/L (lithium intoxication). Further analysis of the medical records of 77 patients with lithium intoxication revealed that while acute kidney injury occurred, renal function after the episode was similar to renal function at baseline. No fatalities occurred in connection with lithium intoxication.
“Ultimately, as lithium intoxication is rare and can be safely managed in most cases, physicians should not withhold lithium for fear of intoxication in patients who benefit from it,” the authors wrote. “In order to manage lithium treatment safely, it is important to educate patients about the risks of lithium toxicity and enable them to understand under which circumstances lithium levels can rise.”
For related news, see the Psychiatric News article “Experts Make Case for Lithium in Youth With Bipolar Disorder.” More information on this topic can also be found in the Bipolar and Related Disorders chapter in The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition.
(Image: iStock/Don Bayley)