Abstract
<i>Introduction</i>: Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, however, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise. As of today, there is no specific antidote for lithium, so intermittent hemodialysis is the strategy of choice for the intoxicated patient. <i>Objectives</i>: To describe the available and relevant literature on the management of Lithium poisoning. <i>Methodology</i>: A search was performed with the MeSH terms "Lithium, Renal Dialysis, Poisoning, Toxicity, Acute kidney injury" in the ClinicalKey, PubMed and Ovid databases search engines, finding 156 results, of which 47 were used to develop this manuscript. <i>Conclusions</i>: Lithium poisoning is frequent due to its narrow therapeutic margin, so serum lithium levels should be monitored in patients medicated with it. Today there is no specific antidote, so renal replacement therapy is the best therapeutic option for lithium poisoning, demonstrating high efficiency, especially in cases of marked neurotoxicity. It is necessary to assess the need to initiate timely management in order to achieve a rapid clearance of the drug and decrease the rate of complications and mortality.
Highlights
Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise
Its history dates back to the 19th century, where it was administered in the form of a tonic to patients with conduct disorders; A long time later, in 1949, John FJ Cade described the “anti-mania” molecular mechanisms of Lithium and in the 1970s, it was approved by the FDA for the treatment of disorders in the bipolar spectrum. [4]
Despite extensive medical experience with the use of lithium as a medicine, its exact mechanism of action is not well defined, its therapeutic effect is thought to be due to impaired sodium transport and catecholamine metabolism due to at the neuronal level [5, 6], this is done through two intracellular signaling pathways: inhibition of inositol monophosphate and inhibition of glycogen synthase kinase-3, which generates a lower capacity of alpha adrenergic response, decreased adenylate cyclase and G protein activity [7]
Summary
Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise. Its history dates back to the 19th century, where it was administered in the form of a tonic to patients with conduct disorders; A long time later, in 1949, John FJ Cade described the “anti-mania” molecular mechanisms of Lithium and in the 1970s, it was approved by the FDA for the treatment of disorders in the bipolar spectrum. The bioavailability in general is good, ranging from 60-95% depending on the presentation; and its “anti-mania” effect begins to be evident between days 5 and 7, achieving clinical effectiveness between the second and third week of treatment [10]
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