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Lithium poisoning and renal replacement therapy: pathophysiology and current clinical recommendations

  • Nephrology - Review
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Abstract

Lithium intoxication is still an undefined and underestimated disease, especially those cases requiring extracorporeal treatment. Lithium is a monovalent cation with small molecular mass of 7 Da that has been regularly and successfully used since 1950 in the treatment of mania and bipolar disorders. However, its careless assumption can lead to a wide spectrum of cardiovascular, central nervous system and kidney diseases in case of acute, acute on chronic and chronic intoxications. In fact, lithium serum range is strict between 0.6 and 1.3 mmol/L, with a mild lithium toxicity observed at the steady-state of 1.5–2.5 mEq/L, moderate toxicity when lithium reaches 2.5–3.5 mEq/L, and severe intoxication with observed serum levels > 3.5 mEq/L. Its favorable biochemical profile allows the complete filtration and partial reabsorption in the kidney due to the similarity to sodium and also the complete removal by renal replacement therapy, that should be considered in specific poisoning conditions. In this narrative and updated review we discussed a clinical case of lithium intoxication, the different pattern of diseases attributable to excessive lithium load and the current indications for extracorporeal treatment.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, Ospedale Sant’ Antonio Abate, AspTrapani, via Cosenza, Erice, TP, Italy

    Leonardo Spatola, Carmelinda Canale & Maria D’Amico

  2. Department of Pediatrics, ISMETT, Palermo, Italy

    Silvio Maringhini

  3. Division of Nephrology and Dialysis, Ospedale Cannizzaro, Via Messina, Catania, CT, Italy

    Antonio Granata

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  1. Leonardo Spatola
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  2. Silvio Maringhini
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  3. Carmelinda Canale
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  4. Antonio Granata
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  5. Maria D’Amico
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Correspondence to Leonardo Spatola.

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Spatola, L., Maringhini, S., Canale, C. et al. Lithium poisoning and renal replacement therapy: pathophysiology and current clinical recommendations. Int Urol Nephrol 55, 2501–2505 (2023). https://doi.org/10.1007/s11255-023-03558-5

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  • DOI: https://doi.org/10.1007/s11255-023-03558-5

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