The open 2‐compartment intracellular/extracellular distribution model requires lithium level serum samples to be obtained at least 10 hours after an oral dose. Epub 2020 Apr 15.Nederlof M, Heerdink ER, Egberts ACG, Wilting I, Stoker LJ, Hoekstra R, Kupka RW.Int J Bipolar Disord.

Use the link below to share a full-text version of this article with your friends and colleagues. The patient was on lithium …



She was not fully cooperative, but was not stiff.


Anti-Inflammatory Drugs, Lithium Toxicity from the Addition of an ACE Inhibitor with an Unexpected Type I Brugada Pattern ECG: Case Files of the Medical Toxicology Fellowship at the University of California, San Diego, Neuroanaesthesia and Coexisting Psychiatric Problems, Lithium and Lisinopril Interaction, Lithium Toxicities, and Relative Preservation of Renal Function in a Patient with Bipolar Disorder, The Combination of Lithium and ACE Inhibitors: Hazardous, Critical, Possible?, Lithium during pregnancy and after delivery: a review, Hypersalivation as an Adverse Drug Reaction Related to Lithium Carbonate, Antihypertensive therapy in patients on chronic lithium treatment for bipolar disorders, A case of lithium intoxication induced by an antihypertensive angiotensin 1 subtype-specific angiotensin II receptor blocker in an elderly patient with bipolar disorder and hypertension, Nippon Ronen Igakkai Zasshi. The patient also suffers from hypertension. [Which antihypertensive drugs in lithium therapy?]. Unable to load your collection due to an error ScienceDirect ® is a registered trademark of Elsevier B.V.The problem of antihypertensive treatment in lithium patientsScienceDirect ® is a registered trademark of Elsevier B.V. : Assistant Professor of Psychiatry, Howard University, Staff Psychi atrist, Saint Elizabeths Hospital, Washington, D.C.We use cookies to help provide and enhance our service and tailor content and ads.

Shortly after hemodialysis her lithium level was 0.65 mEq/L, rising to 1.27 mEq/L 6 hours later, and a second hemodialysis was ordered. 2020 Jul;16(3):321-328. doi: 10.1007/s13181-020-00773-9.

This article hopes to elucidate the complex problems of psychiatric patients requiring simultaneous lithium and antihypertensive drugs.

Another contributing factor was the high therapeutic range drug level felt to be necessary to control this patient’s bipolar disorder, which allowed little leeway. A model including certain albeit not all diuretics and/or inhibitors of the renin-angiotensin system, but not age, serum lithium or creatinine levels at baseline and/or on admission to the hospital, predicted lithium toxicity.



The true incidence of lithium intoxication is unknown but probably low, albeit underestimated. This article hopes to elucidate the complex problems of psychiatric patients requiring simultaneous lithium and antihypertensive drugs. Another examiner noted her to be able to very slowly state her name and birth date. By continuing you agree to the Copyright © 2020 Elsevier B.V. or its licensors or contributors.

Conversely, drugs that alter renal function can modify its serum levels and lead to the potentially fatal lithium intoxication. Her eyes were frequently closed. Up until 5 years prior to admission the patient had multiple psychiatric hospitalizations, but since that time had achieved good stabilization on lithium carbonate 300 mg twice a day with a lithium level of 1.10 mEq/L (therapeutic, 0.3–1.3 mEq/L) 2 months prior to admission.

PMID: 1870446 [Indexed for MEDLINE] Letter Humans Please enable it to take advantage of the complete set of features! 2018 Apr 14;6(1):12. doi: 10.1186/s40345-018-0120-1.Clin Drug Investig. doi: 10.1097/MJT.0000000000000224.J Med Toxicol. Serum creatinine was 2.5 mg/dL and lithium level was 2.88 mEq/L.Emergent hemodialysis with a bicarbonate bath was prescribed, and hydrochlorothiazide, lisinopril, and lithium were held. Author information: (1)Institut für Pharmakologie, Heinrich-Heine-Universität, Düsseldorf. Therefore, for a patient taking lithium started on a thiazide, a 40% decrease in lithium dose would be a safe approximation,In drug studies of healthy volunteers investigating pharmacologic effects, there are usually nonsignificant decreases in lithium levels when patients are coadministered furosemide and other loop diuretics, attributed to the distal renal tubular site of action of these agents that promote excretion of both sodium and lithium.The effect of angiotensin‐converting enzyme (ACE) inhibitors on lithium excretion is variable and reports of toxicity compared with thiazide diuretics are less common. 2013 Oct 24;347:f6008. e potentially fatal lithium intoxication.

A regression analysis showed that the severity of lithium intoxication was significantly predicted by female, age, and use of certain classes of antihypertensive agents.

Several, but not all, antihypertensives can have serious interactions with lithium leading to either toxicity or, less commonly, decreased levels.
Choosing an antihypertensive medicine. Here is a brief, simple, and practical guide.