Mg Of Lithium Research Articles

Serotonin Syndrome in an Adolescent Following Overdose of Escitalopram and Lithium: A Case Report

Abstract In routine clinical practice, some patients consume overdose of more than one medication, that makes it difficult to identify the toxic syndrome. In this report, we present the case of a 16-year female who was brought to the emergency with an alleged account of an overdose of tablet lithium and tablet escitalopram. A 16-year female, suffering from depression for about 4-months, and was on treatment consumed approximately 3000 mg of lithium and 150 mg of escitalopram with the intention to die. At presentation (after 12 h of the overdose), her Glasgow Coma Scale score was E3V1M6, her blood pressure was 70/50 mm Hg, her pulse rate was 84 beats/min, her respiratory rate was 24 breaths/min, and she was afebrile. On physical examination, she was found to have diaphoresis, mydriasis, ocular clonus, patellar clonus, ankle clonus, hyperreflexia, rigidity, increased bowel sound, and whole-body tremulousness. On mental state examination she was found to be delirious to stuporous. In view of the toxicity, initially a diagnosis of serotonin syndrome and lithium toxicity was considered. Considering the availability of antidote, it was decided to manage the patient first in the line of serotonin syndrome. She should dramatic improvement with cyproheptadine and stabilized in 48 h. Her lithium levels also normalized with supportive management during the same time frame. The index case highlights the fact that when a patient presents with toxicity of more than one psychotropic, with antidepressants being one of them, SS should always be suspected and managed rapidly with the antidote.

600 mg of Lithium, Quarantine, and "Third-Spaces"

With a mix of prose, critical reflection, and an accompanying series of drawings inside a daily planner, this intimate essay reimagines multiple conceptions of "space" in relation to different kinds of sickness and wellbeing. Meditating on COVID-19 quarantine spaces and bipolar disorder mood/mind-spaces allowed me to discover messied "third" spaces that explore margins, and complicate ideas of boundaries and binaries. Doing so allowed me to think through new possibilities of healing, restoration, and intimacy when we talk about mental health. I offer up my personal account of a young female Asian American graduate student navigating a ten-year struggle with clinical bipolar disorder, and the personal experiences of "madness," relapse, and recovery during the winter and spring of 2021. I reflect on my daily routines inside my 800-square-foot apartment and my growing realization that prevailing ideas of "space" are incomplete and contradictory—but can be replete with futurities and learning possibilities. Fittingly, this creative piece does not endeavor to offer any neatly packaged analysis or solid conclusions. Instead, I present one account of grappling with mental illness under extraordinary circumstances and hope it can speak to individual and collective discussions on mental health, disability, and spatiality.

Somnambulism induced by Hydroxyzine

IntroductionSomnambulism or sleepwalking could be explained by dysfunction in the regulation of slow-wave sleep. It may be caused by drugs; in the literature, cases of somnambulism that occurred by olanzapine and lithium have been reported.ObjectivesDiscuss the association between somnambulism and Hydroxyzine.MethodsWe will discuss the case of a patient with bipolar disorder treated with olanzapine and lithium who experienced episodes of somnambulism after adding Hydroxyzine.ResultsA 42-year-old woman, with no history of somnambulism, followed in our department for a bipolar disorder type 1, treated with 750 mg of lithium and 20 mg of olanzapine. During her usual control, she reported insomnia Hydroxyzine was added at the dose of 50 mg. At the next medical appointment, she said that her husband had noticed that she waked up at night and she eats, she ambulates and searches things. Episodes that the patient did not remember. She was tranferd to the neurolgic departement. She did a neurological exam, an electroencephalogram, and a brain scan, witch were normal. The polysomnography confirmed the diagnosis. The neurologist retained the diagnosis of somnambulism induced by Hdroxizine regarding the chronology of the symptoms. The somnambulism ceased after stopping Hydroxyzine.ConclusionsLithium and olanzapine were associated with the occur of somnambulism, but hydroxyzine had never been reported as a somnambulism drug inducing. Drug interaction may explain this phenomenon.DisclosureNo significant relationships.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Drug-induced arrhythmia: Are we cautious enough?

Dear Editor, Many drugs, like antiarrhythmic agents, psychotropic medications, neurological drugs, and even antimicrobial agents, may trigger multiple types of arrhythmias.[1] Some arrhythmias may cause serious consequences, including death. We report a rare incident where psychotropic medications not only precipitated a life-threatening arrhythmia but also a stroke! A 64-year-old man with a history of bipolar disorder had no other comorbidity. He presented to the ER (emergency room) with hypotension and bradycardia. His GCS (Glasgow Coma Scale) score was 15/15 and had no neuro-deficit. We detected idioventricular rhythm, and a temporary pacemaker was implanted. His hypotension improved, and it stabilized him. We planned a permanent pacemaker the next morning. The family gave a history that he was on 400 mg of lithium and 400 mg of carbamazepine for more than a year. Considering their arrhythmogenic potential, they were withheld. (Blood lithium level was in the normal range.) The next morning we detected him to have right gaze deviation and left-sided complete hemiplegia (NIHSS of 17). He had established an infarct at the right frontal–temporal region with hemorrhagic conversion in the MRI (magnetic resonance imaging) brain [Figure 1a]. MRA (magnetic resonance angiography) brain revealed right M2 occlusion [Figure 1b]. Conservative stroke treatment along with rehabilitation was executed. TEE (transesophageal echocardiography) ruled out intracardiac clot and other cardiac pathology. Details of stroke workup were also not contributory. Since his sinus rhythm persisted even after removal of the temporary pacemaker, we canceled a permanent pacemaker implantation. We withdrew his offending drugs permanently. Henceforth, the cardiology team monitored the cardiac rhythm and until 2 years of follow-up, he had no further event. His Modified Rankin Scale (mRS), however, remained 5 (with no significant improvement).Figure 1: (a) Acute infarct with hemorrhagic conversion in the right frontal and temporal region. (b) Right M2 division of middle cerebra artery occludedThey associated junctional bradycardia with ischemic stroke, particularly in the absence of an identifiable retrograde P-wave.[2] He had the stroke just after his rhythm got converted to sinus rhythm from junctional bradycardia (like thromboembolism as happens in AF (atrial fibrillation) patients shortly after they get cardioverter).[3] Carbamazepine and lithium both can precipitate bradyarrhythmia.[45] Although we found his lithium level to be within range, there are reports where lithium has precipitated bradyarrhythmia even when the drug level was within therapeutic range.[5] The drugs might have had a synergistic action in our case causing precipitation of the bradyarrhythmia. Interesting learning points in our case are as follows: Arrhythmogenic drugs can precipitate stroke. While on these types of drugs, caregivers should monitor the heart rate and blood pressure regularly. Careful selection of drugs in psychiatric patients is important because they may have a synergistic action in causing arrhythmogenic insults. Before opting for a permanent pacemaker, careful history taking is important to isolate culprit drugs if any which might have precipitated arrhythmia. The status of the arrhythmia needs to be observed after their withdrawal before taking further action. In cardioversion, conversion to sinus rhythm may cause sudden dislodgement of clots from the heart, leading to systemic embolization. Similarly, the stoppage of the arrhythmogenic drugs may precipitate a similar event. So, we need to be more cautious during this time. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement We acknowledge the faith the patient and family kept on us during difficult times.

Simultaneous lithium bioleaching and bioaccumulation from lepidolite using microscopic fungus Aspergillus niger

The leaching of lithium from lepidolite using the filamentous fungus Aspergilluss niger was examined. Two mechanisms were suggested – biochemical using citric acid as the main bioleaching agent and biomechanical through hyphae penetration confirmed by XRD and SEM analyses. The bioleaching processes were conducted at various glucose concentrations (5 – 20 g.L-1). The higher glucose concentration was, the higher Li bioleaching was observed. Li accumulation by fungal biomass played an important role in Li solubilisation from lepidolite. Totally, 11.5 mg of lithium were recovered from 1 kg of lepidolite by combination of bioleaching and bioaccumulation processes. As a result of bioleaching, the formation of new silicate phase of SiO2 was detected. According to the results, fungal bioleaching of Li from lepidolite can be a perspective way of Li recovery from hard-rock ores.

Use of Lithium in Severe Acute Manic Episodes: Retrospective Prescription Practice From a Tertiary Inpatient Unit.

A retrospective chart review was performed to investigate the common preferences of clinicians for the pharmacological treatment of acute manic episodes, with particular regard to lithium use, and to assess the adherence of clinical practice to established guidelines. Cases of manic episodes in patients admitted to Bakirköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital were retrospectively reviewed. Length of stay, medication data, serum levels, and adverse effects were evaluated for patients who received lithium therapy (N=98). On the first day of lithium treatment, 81 patients received 900 to 1200 mg of lithium. In total, 44 patients were discharged with the same dose as that given on the first day of treatment. With the exception of 1 patient, the dose was increased by 300 to 600 mg in the remaining patients within the first 10 days on the basis of serum drug concentrations. The mean serum concentrations of lithium in the first week were 0.67±0.17 mEq/L in patients with no dose increase, and 0.51±0.15 mEq/L in patients who did receive a dose increase. In total, 94 patients received at least 1 antipsychotic medication in addition to lithium. Clinicians attempted to maintain serum lithium levels above 0.60 mEq/L at the time of acute treatment initiation, consistent with established guidelines. Clinical practice in large inpatient settings may force clinicians to use lithium in combination with antipsychotics for the treatment of acute mania; the delayed action of lithium and the need for rapid stabilization may drive these practices.

Development of undersized (12.5 mm diameter) low‐dilution glass beads for X‐ray fluorescence determination of 34 components in 200 mg of igneous rock for applications with geochemical and archeological silicic samples

A low‐dilution, undersized (12.5 mm diameter) glass–bead technique was developed for X‐ray fluorescence determination of 34 components (Na2O, MgO, Al2O3, SiO2, P2O5, K2O, CaO, TiO2, MnO, Fe2O3, V, Cr, Co, Ni, Cu, Zn, Rb, Sr, Y, Zr, Nb, Cs, Ba, La, Pr, Nd, Sm, Gd, Dy, Er, Yb, Hf, W, and Pb) in precious silicic samples for geochemistry and archeology. This preparation was consolidated based on the properties of the specimen, including disk formability and detachability from a small crucible, through variation of the amounts of the two samples (basaltic and granitic rocks) and releasing reagent. The specimen was prepared by fusing a mixture of 200 mg of powdered sample, 200 mg of lithium tetraborate as a flux, and 60 µl of 18.42 mass% lithium chloride solution as a releasing agent in a small platinum crucible. Calibration curves were drawn using synthetic calibration standards, which were prepared by compounding chemical reagents, such as oxides, carbonates, and diphosphates containing analytes. The calibration curves showed good linearity with correlation coefficient values greater than 0.990. Using the proposed method, we determined 34 components in five igneous rock reference samples. The results were in agreement with the recommended values, accounting for uncertainties. With this method, preparation requires only small amounts of the powdered sample and alkali flux; however, still allowing for determination of many analytes, which is advantageous when dealing with limited quantities of precious samples. The present method has potential applications in the chemical characterization of various geological and archeological samples. Copyright © 2015 John Wiley & Sons, Ltd.

Lithium Remains a Viable Option for People With Bipolar Disorder

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessLithium Remains a Viable Option for People With Bipolar DisorderVabren WattsVabren WattsSearch for more papers by this authorPublished Online:6 Jul 2015https://doi.org/10.1176/appi.pn.2015.7a15AbstractDespite studies demonstrating the effectiveness of lithium for the treatment of bipolar disorder, its use in clinical practice in the United States is declining, experts say.“Who here has heard of lithium?” asked Michael Ostacher, M.D., an associate professor of psychiatry at Stanford University School of Medicine, during a session at APA’s 2015 annual meeting in May on treating bipolar disorder. Michael Ostacher, M.D., believes that it’s important to continue research on all treatments for bipolar disorder, even treatments that are less utilized such as lithium.David HathcoxOstacher deemed the question—which was followed by a light chuckle from the audience—as relevant because though the drug has been a well-established treatment for bipolar disorder for 45 years, its use, at least in the United States, is declining. “This decline [in lithium prescribing] is understandable,” said Ostacher, who explained to session attendees that the underutilization of the drug may be partly attributed to the marketing surge for other FDA-approved drugs for the treatment of bipolar disorder. According to Ostacher, previous research from insurance databases in the United States suggests antidepressants—initiated at diagnosis and continually used one year after diagnosis—are the most commonly prescribed therapy for bipolar disorder. This research shows that 70 percent of individuals diagnosed with bipolar disorder have been prescribed antidepressants compared with roughly 12 percent who have been prescribed lithium.During his talk, Ostacher presented data from his recent work comparing the effectiveness of lithium with that of other medications in the treatment of bipolar disorder, including the results of BALANCE (Bipolar Affective disorder Lithium/Anticonvulsant Evaluation)—a multisite, randomized, open-labeled comparison study with lithium and the anticonvulsive divalproex. The study, which included 330 adults with bipolar I disorder, showed that the risk of symptom relapse was reduced by 41 percent in patients who took a combined daily dosage of lithium (0.4 mmol) and divalproex (1,250 mg) over a two-year period. The risk of symptom relapse was reduced by 29 percent in patients who took lithium alone and 18 percent in patients who took divalproex alone.“This primarily said that lithium or lithium in combination with divalproex was more effective than divalproex alone,” said Ostacher. “This totally contradicts the way we initiate treatment for bipolar disorder in our patients in the U.S.” Ostacher mentioned that one of the limitations of the study was that most of the sample population was on a monotherapy prior to the study, whereas a significant number of people, particularly in the United States, take multiple medications at once. A study by Andrew Nierenberg, M.D., and colleagues compared the effectiveness of lithium with the antipsychotic quetiapine in 482 patients with bipolar I or bipolar II disorder and at least one comorbid mental health condition. The patients were given a mean dose of 1,008 mg of lithium or a mean dose of 345 mg of quetiapine daily for six months while continuing to take medications for their other mental health conditions. The researchers tracked changes in the severity of bipolar disorder–related symptoms reported by patients—as measured by the scale of Clinical Global Impression for Bipolar Disorder Efficacy Index (CGI-BP EI)—and how frequently providers altered dosages of the medications due to side effects or lack of efficacy, known as necessary clinical adjustments (NCAs). The analysis found both lithium and quetiapine to be equally effective in reducing symptom severity related to bipolar I and II disorder in patients at the study end point. However, the lithium group had significantly fewer NCAs per month than the quetiapine group.After the session, Ostacher told Psychiatric News that “if we learn how to use it properly and safely in patients, lithium can be a mainstay medication for some patients.” He emphasized that it is important for experts in the field to conduct more reliable studies that will provide confident enough results that would increase lithium use in clinical practice. “There are multiple treatment options available to treat bipolar disorder. We just need to have enough information—on all options—to be able to determine which option is best for our patients,” Ostacher concluded. ■ ISSUES NewArchived

Lithium: A switch from LTD- to LTP-like plasticity in human cortex

Lithium, a simple cation, is the mainstay treatment of bipolar disorder. Deficient synaptic plasticity is considered one important mechanism of this disease. Lithium inhibits glycogen synthase kinase-3beta (GSK-3β), which is involved in the regulation of synaptic plasticity. In animal preparations, inhibition of GSK-3β by lithium up-regulated long-term potentiation (LTP) of excitatory synapses but down-regulated long-term depression (LTD). The effects of lithium on plasticity in the human brain are unexplored. We tested the effects of a single oral dose of 900 mg of lithium on LTP-/LTD-like plasticity in human motor cortex induced by established paired associative transcranial magnetic stimulation (PAS(LTP), PAS(LTD)) protocols. We studied 10 healthy adults in a placebo-controlled double-blind randomized crossover design. PAS-induced plasticity was indexed by change in motor evoked potential amplitude recorded in a hand muscle. In the placebo session, subjects were stratified, according to the known variability of the PAS(LTP) response, into PAS(LTP) 'LTP responders' and PAS(LTP) 'LTD responders' (n = 5 each). Lithium did not affect the PAS(LTP)-induced LTP-like plasticity in the 'LTP responders', but switched the PAS(LTP)-induced LTD-like plasticity in the 'LTD responders' to LTP-like plasticity. In contrast, lithium had no effect on the PAS(LTD)-induced LTD-like plasticity in the 'LTD responders'. We provide first-time evidence that lithium significantly modulates brain stimulation induced plasticity in human cortex. The switch from LTD- to LTP-like plasticity is best explained by the inhibitory action of lithium on GSK-3β. This conclusion is necessarily circumstantial because GSK-3β activity was not directly measured. We discuss that other important plasticity-related modes actions of lithium cannot explain our findings.

Dosing Strategies for Lithium Monotherapy in Children and Adolescents with Bipolar I Disorder

The primary goal of this exploratory study was to obtain data that could lead to evidence-based dosing strategies for lithium in children and adolescents suffering from bipolar I disorder. Outpatients aged 7-17 years meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for bipolar I disorder (manic or mixed) were eligible for 8 weeks of open label treatment with lithium in one of three dosing arms. In Arm I, participants began treatment at a dose of 300 mg of lithium twice daily. The starting dose of lithium in Arms II and III was 300 mg thrice daily. Patients in Arms I and II could have their dose increased by 300 mg/day, depending on clinical response, at weekly visits. Patients in Arm III also had mid-week telephone interviews after which they could also have their dose of lithium increased by 300 mg per day. Youths weighing <30 kg were automatically assigned to Arm I, whereas youths weighing ≥30 kg were randomly assigned to Arm I, II, or III. Randomization was balanced by age (7-11 years, 12-17 years) and sex in approximately equal numbers. A priori response criteria were defined as a Clinical Global Impressions-Improvement scale score of ≤ 2 and a 50% decrease from baseline on the Young Mania Rating Scale. Of the 61 youths [32 males (52.5%)] who received open-label lithium, 60 youths completed at least 1 week of treatment and returned for a postbaseline assessment. Most patients had a ≥ 50% improvement in Young Mania Rating Scale score, and more than half of the patients (58%) achieved response. Overall, lithium was well tolerated. All three treatment arms had similar effectiveness, side effect profiles, and tolerability of lithium. On the basis of these results, a dosing strategy in which pediatric patients begin lithium at a dose of 300 mg thrice daily (with an additional 300 mg increase during the first week), followed by 300 mg weekly increases until a priori stopping criteria are met, will be used in an upcoming randomized, placebo-controlled trial.

Bipolar Disorder and Pregnancy: Maintaining Psychiatric Stability in the Real World of Obstetric and Psychiatric Complications

This article describes complex, real-life issues faced by a woman with bipolar I disorder who wished to bear a healthy child while remaining psychiatrically well. The therapeutic issues include balancing treatment decisions that affect fetal and maternal risks. The authors address the importance of carefully considering the patient’s history of response to medications when evaluating risks to maternal and fetal health. They discuss the role of the psychiatrist as a part of the treatment team faced with unpredictable but not unexpected complexities, such as miscarriage, abnormal or questionable prenatal screening tests, gestational diabetes, and the emergence of fetal decelerations, preterm labor, and psychiatric decompensation. The article presents and evaluates treatment decisions made in the setting of multiple obstetric and psychiatric complications that do not clearly fit published algorithms. The importance of incorporating family and social supports as an integral part of the treatment plan is emphasized.

Lithium toxicity from an internet dietary supplement

The widespread availability of medications and herbal products on the Internet has increased the potential for poisonings. We are reporting a case of mild, acute lithium toxicity occurring after the intentional misuse of a lithium-containing "dietary supplement" (Find Serenity Now) obtained over the Internet. An 18-year-old woman presented to our emergency department (ED) after ingesting 18 tablets of Find Serenity Now; each tablet contained, according to the listing, 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic) lithium carbonate]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. Almost 90 minutes after the ingestion, her serum lithium level was 0.31 mEq/L, a urine drug screen was negative, and an electrocardiogram (ECG) showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic; one hour later, her repeat serum lithium level was 0.40 mEq/L. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Prior human and animal data have shown similar pharmacokinetics and shared clinical effects of these lithium salts. Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.

Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers

Sensitivity of the pineal hormone melatonin to bright light at night has been posited as a putative marker of affective disorders. Research demonstrates melatonin supersensitivity to light in bipolar disorder, however the role that lithium carbonate plays in this response is unclear. This study assessed the effect of lithium on nocturnal melatonin secretion and sensitivity to light in healthy adults. Ten participants, tested on two nights, had blood samples drawn between 20:00 and 02:30 hours. On testing nights participants were exposed to 200 lux of light between 24:00 and 01:00 hours. Participants took 250 mg of lithium daily for 5 d between testing nights. The results indicated that lithium had a significant effect on sensitivity to light but not on overall melatonin synthesis. This finding has implications on the true magnitude of the melatonin light response in people with bipolar disorder and may elucidate possible mechanisms of action of lithium.

Hypotension Resistant to Therapy with alpha Receptor Agonists Complicating Cardiopulmonary Bypass

Hypotension Resistant to Therapy with alpha Receptor Agonists Complicating Cardiopulmonary Bypass

Wall conditioning with lithium evaporation

Thin lithium layers are deposited on metal or graphite walls by evaporation in vacuum. Clean lithium surfaces have wide chemical activities on such gases as O2, CO and CH4. In particular, a strong gettering effect on oxygen is observed; the maximum number of O atoms gettered by the lithium layer is about one half the total number of Li atoms deposited on the wall, thus suggesting the formation of Li2O. On the other hand, H2 gas hardly reacts with the lithium surface which, however, displays a large pumping effect in a hydrogen glow discharge. The maximum number of H atoms pumped by the lithium layer below 180°C is approximately equal to the number of Li atoms in the vessel, probably due to the formation of LiH. Helium glow conditioning of the used lithium layer allows the partial recovery of lithium from losses to hydrogen pumping or oxygen gettering. This lithium evaporation method has been applied to JIPP T-IIU. 100–250 mg of lithium was deposited onto a limited vessel area of ∼ 1 m2. The lithium coating leads to 20–50% reduction in oxygen and carbon impurities with less hydrogen recycling in ohmic and NBI discharges.

Psychotropic Medications During Pregnancy: Risk to the Fetus

To the Editor. —I was excited to read the article by Pastuszak et al1reporting on a prospective study of 128 women who took therapeutic doses of fluoxetine during their first trimester of pregnancy compared with the pregnancy outcome of two matched groups of women exposed to either nonteratogens or tricyclic antidepressants. Rates of major congenital malformations were similar for the three groups. This prospective study follows close on the heels of two studies reported inLancetin 1992. Jacobson et al2reported in a prospective study the pregnancy outcome after lithium exposure during the first trimester of pregnancy, and Bergman et al3published the results of a study of exposure to benzodiazepines during fetal life using a retrospective approach. In the first study,2women taking an average of 927 mg of lithium were compared with a control group of pregnant women who were taking drugs

Lithium clearance method and the renal response to low-dose dopamine in man: a randomized, controlled study

1. The effect of a single dose of lithium on renal function before and during intravenous infusion of dopamine (3 micrograms min-1 kg-1) was investigated in 12 healthy males. In a double-blind and randomized design, 450mg or 600mg of lithium carbonate or placebo was administered orally at 22.00 hours on three different occasions. After an overnight fast, the subjects were water-loaded and clearance studies were started at 09.00 hours with a 1h baseline period and three 1h periods during dopamine infusion. 2. Baseline sodium clearance with placebo was 0.65 +/- 0.35 ml/min, but with lithium it increased to 1.25 +/- 0.44 (P < 0.001) and 1.17 +/- 0.46 ml/min (P < 0.01) after 450 and 600mg, respectively. Urine flow rates were unchanged compared with placebo. Lithium did not significantly affect glomerular filtration rate, but both doses slightly increased effective renal plasma flow by 7% (P < 0.05) and 10% (P < 0.01), respectively. 3. The maximal natriuretic and diuretic effects of dopamine were not reduced by lithium, but the percentage increases in sodium clearance were significantly diminished after 450mg (P < 0.01) and 600mg (P < 0.001) of lithium. Lithium had no effect on dopamine-induced changes in effective renal plasma flow, glomerular filtration rate or osmolal clearance. Neither lithium nor dopamine influenced plasma concentrations of renin, aldosterone or atrial natriuretic peptide. 4. In conclusion, single test doses of lithium, as normally used in lithium clearance studies, increase baseline values of sodium clearance and effective renal plasma flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Lithium pretreatment affects renal and systemic responses to angiotensin II infusion in normal man

1. Renal and systemic responses to infusion of angiotensin II (1.25 and 2.5 ng min-1 kg-1 body weight) were examined in ten normal males 12 h after single doses of 750 mg of lithium carbonate, 250 mg of lithium carbonate (n = 6) or placebo. 2. Baseline mean arterial pressure [mean (SEM)] was higher after 750 mg of lithium [93.1 (1.7) versus 89.5 (1.9 mmHg, P = 0.014], and the subsequent rise in blood pressure during angiotensin II infusion was lower [8.2 (1.8) versus 12.2 (2.4) mmHg, P less than 0.02]. 3. Lithium at a dose of 750 mg increased overnight urinary sodium excretion before the study. The fall in fractional sodium excretion during angiotensin II infusion was reduced after pretreatment with 750 mg of lithium [750 mg of lithium, 2.73 (0.24) to 1.34 (0.08)%; placebo, 2.69 (0.26) to 1.01 (0.11)%; P = 0.02]. The increases in effective filtration fraction [750 mg of lithium, 5.4 (1.0)%; placebo, 8.6 (0.7)%; P less than 0.05] and total effective renal vascular resistance [750 mg of lithium, 3700 (390) dyn s cm-5; placebo 5100 (460) dyn s cm-5; P = 0.03] during angiotensin II infusion were also attenuated after 750 mg of lithium. Responses after 250 mg of lithium did not differ from those after placebo. 4. The fall in plasma renin activity and the increase in plasma aldosterone concentration during angiotensin II infusion were similar on each study day. 5. Renal responses to exogenous angiotensin II are altered after pretreatment with a 750 mg dose of lithium in normal man. This dose of lithium is not an inert marker of sodium handling.

The hypnic headache syndrome.

SYNOPSISSix patients, all but one, men, between the ages of 65 and 77 years, were regularly awakened from sleep at a consistent time of night, sometimes during a dream, by a diffuse headache that persisted for 30 to 60 minutes and was often associated with nausea, without autonomic symptoms. In all cases, headache ceased or was substantially attenuated by a bedtime dose of 300 to 600 mg of lithium. The disorder persisted for one and a half to three years in three of the patients; the others continue to require lithium. It is proposed that this syndrome may be caused by perturbation of a biological clock.