Bregman et al identified patients with lithium toxicity associated with lactulose therapy. This can help to identify a patient who should be closely monitored for lithitum intoxication. The authors are from the University of California at Davis and the Sacramento County Mental Health Treatment Center in Sacramento.

Patient selection: lithium therapy


Outcome: lithium intoxication


Proposed mechanism: gastrointestinal water loss with volume depletion, resulting in resorption of sodium and lithium in the proximal tubules of the kidney


Risk factors for lithium intoxication:

(1) aggressive or high dose therapy with the osmotic laxative

(2) dehydration

(3) renal impairment


Patients who may be at risk include:

(1) hepatic encephalopathy

(2) bowel preparation

(3) warm environmental temperatures

(4) disturbed thirst perception or inability to respond to thirst (as in coma)


Clinical response:

(1) Monitor serum lithium levels in patients receiving an osmotic laxative.

(2) Monitor patients for volume depletion and dehydration.

(3) Keep the patient well-hydrated.

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