A patient with lithium poisoning may benefit from extracorporeal toxin removal.
Methods of extracorporeal therapy:
(1) intermittent hemodialysis
(2) continuous renal replacement therapy (CRRT)
Predictive factors of severe lithium poisoning (Vodovar et al):
(1) admission Glasgow coma score <= 10
(2) admission serum lithium concentration >= 5.2 mmol/L
Indications of Vodovar et al for extracorporeal therapy:
(1) peak serum lithium concentration >= 5.2 mmol/L
(2) peak serum creatinine >= 200 µmol/L
Indications of Decker et al for extracorporeal therapy:
(1) decreased level of consciousness
(2) seizures
(3) life-threatening dysrhythmias
(4) impaired renal function AND serum lithium concentration > 4 mmol/L
Decker et al suggest extracorporeal therapy if:
(1) the serum lithium concentration is > 5 mmol/L
(2) the patient is confused
(3) the time expected to reach a serum lithium concentration < 1 mmol/L by other methods is > 36 hours
The goal of therapy is a serum lithium concentration < 1 mmol/L OR clinical improvement.
The patient should be monitored after therapy to determine if additional extracorporeal therapy is indicated.
