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Lithium Toxicity in Older Adults: a Systematic Review of Case Reports

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Abstract

Background and Objectives

Despite concerns regarding the vulnerability of older adults to lithium toxicity, this has not been well studied. This literature review aims to characterize the nature of lithium toxicity in older adults, the doses and serum lithium levels associated with toxicity, as well as its clinical and laboratory manifestations, precipitating factors, management and outcome.

Methods

A systematic 10-year search of English articles was conducted using Ovid Medline, Embase Classic + Embase, Cochrane Central Register of Controlled Trials and PsycINFO. All studies on lithium toxicity in elderly (aged ≥ 65 years) where the dose of lithium or serum lithium level was clearly described, were included.

Results

There were no clinical trials or cohort studies found. The search identified 38 cases of lithium toxicity in older adults with a mean age of 71.4 years (SD = 5.53). Mean dose of lithium was 675.4 mg/d (SD = 200.66), and mean toxic serum concentration was 2.55 mmol/L (SD = 2.22). Manifestations varied, with neurotoxicity being the most common, followed by renal and cardiovascular toxicity. Polypharmacy (63.2%) and medical comorbidity (76.3%) were common. Intravenous hydration and hemodialysis were widely used for treatment with good effect. Most patients recovered fully, and only one patient died despite treatment.

Conclusion

In published case reports, the lithium dose was higher than recommended for older adults. Polypharmacy and comorbidities appeared to be important precipitating factors of lithium toxicity. Regular monitoring of serum lithium concentrations and appropriate caution should be exercised, even when serum lithium concentrations are within reported therapeutic levels.

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Authors and Affiliations

  1. Department of Psychiatry, The Second Xianga Hospital, Central South University, Changsha, 410011, Hunan, China

    Meng Sun

  2. China National Clinical Research Center on Mental Health Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China

    Meng Sun

  3. Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada

    Meng Sun, Nathan Herrmann & Kenneth I. Shulman

  4. Department of Psychiatry, University of Toronto, Toronto, Canada

    Meng Sun, Nathan Herrmann & Kenneth I. Shulman

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  1. Meng Sun
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Correspondence to Meng Sun.

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Conflict of interest

Dr. Herrmann has received research support from Roche, Lundbeck and Axovant, and consultation fees from Mediti, Astellas, Merck and Lilly. Drs. Sun and Shulman declare that they have no conflict of interest.

Funding

Dr. Sun was supported by the Chinese Scholarship Council (201606370190) during the fellowship. Dr. Herrmann was supported by a grant from the Ontario Mental Health Foundation.

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Sun, M., Herrmann, N. & Shulman, K.I. Lithium Toxicity in Older Adults: a Systematic Review of Case Reports. Clin Drug Investig 38, 201–209 (2018). https://doi.org/10.1007/s40261-017-0598-9

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