Hemodialysis for lithium poisoning

Background

Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, whether due to reduced excretion by the kidneys or overdose, can cause permanent injury to the nervous system. Hemodialysis is a process in which a person's blood is filtered outside of their body, by a machine, and then returned to the person's body. Hemodialysis effectively removes lithium from the body, and has been used to treat lithium poisoning for at least 40 years. However, it is not known whether hemodialysis, performed in addition to standard therapy with intravenous fluids, reduces or eliminates damage to the nervous system.

Search date

The information in this review is up to date to 15 May 2015.

Study characteristics

This review found no randomized controlled trials assessing the use of hemodialysis to treat lithium poisoning.

Key results

Although the use of hemodialysis to remove lithium from patients with lithium poisoning is logical, no randomized clinical trials support or disprove a benefit from this therapy.

Authors' conclusions: 

Although the use of hemodialysis to enhance the elimination of lithium in patients with lithium poisoning appears logical, there is no evidence from randomized controlled trials to support nor refute the use of hemodialysis in the management of patients with lithium poisoning.

Read the full abstract...
Background: 

Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is often recommended to treat lithium poisoning. Although hemodialysis clearly enhances the elimination of lithium, it is unclear whether this translates into improved patient outcomes. Evidence from observational studies, generally of low methodological quality, shows similar outcomes in patients managed with or without the use of hemodialysis.

Objectives: 

To determine whether hemodialysis, applied in addition to standard therapy, reduces the likelihood, severity, or duration of neurological sequelae following lithium poisoning.

Search strategy: 

We ran the search on 15 May 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase Classic+Embase (OvidSP), CINAHL Plus, clinical trials registers and four other databases. We screened the reference lists of relevant studies, textbook chapters, and review articles, and performed a Google search to identify grey literature.

Selection criteria: 

In the context of this review, hemodialysis was defined as any extracorporeal technique to filter and extract toxicants from the serum, including all forms of hemodialysis, hemofiltration, and continuous renal replacement techniques, but not peritoneal dialysis. We included any clinical trials in which patients were randomly allocated to receive, or not receive, hemodialysis in addition to standard care for lithium poisoning.

Data collection and analysis: 

Two authors reviewed the abstracts of all identified articles. If either author identified an article as potentially meeting the inclusion criteria, both authors reviewed the full text of the article.

Main results: 

No randomized controlled trials of hemodialysis therapy for lithium poisoning were identified.

Share/Save
Health topics: