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Liu YH, Tsai KF, Hsu PC, Hsieh MH, Fu JF, Wang IK, Liu SH, Weng CH, Huang WH, Hsu CW, Yen TH. Hemodialysis Treatment for Patients with Lithium Poisoning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10044. [PMID: 36011678 PMCID: PMC9408339 DOI: 10.3390/ijerph191610044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Hemodialysis is often recommended to treat severe lithium poisoning. Nevertheless, the application rate of hemodialysis in patients with lithium poisoning is varied across different groups and the effect of hemodialysis is still undetermined. Therefore, this study aimed to analyze the hemodialysis rate of patients with lithium poisoning and to explore the clinical features of lithium-poisoned-patients treated or untreated with hemodialysis. METHODS Between 2001 and 2019, 36 patients treated at the Chang Gung Memorial Hospital for the management of lithium poisoning were stratified according to whether they were treated with hemodialysis (n = 7) or not (n = 29). RESULTS The patients were aged 50.7 ± 18.1 years. The poisoning patterns were acute on chronic (61.1%), chronic (25.0%) and acute (13.9%). The precipitating factors of dehydration and infection were noted in 36.1% and 25.0% of patients, respectively. Bipolar disorder (72.2%), depressive disorder (27.8%) and psychotic disorder (11.1%) were the top three psychiatric comorbidities. The hemodialysis group not only had a lower Glasgow Coma Scale (GCS) score (p = 0.001) but also had a higher respiratory failure rate (p = 0.033), aspiration pneumonia rate (p = 0.033) and acute kidney injury network (AKIN) score (p = 0.002) than the non-hemodialysis group. Although none of the patients died of lithium poisoning, the hemodialysis group required more endotracheal intubation (p = 0.033), more intensive care unit admission (p = 0.033) and longer hospitalization (p = 0.007) than the non-hemodialysis group. CONCLUSION The analytical results revealed zero mortality rate and low hemodialysis rate (1.9%). Compared with patients without hemodialysis, patients receiving hemodialysis suffered severer lithium-associated complications and needed a more intensive care unit admission and longer hospital stay.
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Affiliation(s)
- Yu-Hsin Liu
- Department of Anaesthesiology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Kai-Fan Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Pai-Chin Hsu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Meng-Hsuan Hsieh
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan
| | - Jen-Fen Fu
- Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung 406, Taiwan
| | - Shou-Hsuan Liu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Cheng-Hao Weng
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Wen-Hung Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Ching-Wei Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
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Jing H, Wang F, Gao XJ. Lithium intoxication induced pyroptosis via ROS/NF-κB/NLRP3 inflammasome regulatory networks in kidney of mice. ENVIRONMENTAL TOXICOLOGY 2022; 37:825-835. [PMID: 34984798 DOI: 10.1002/tox.23446] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/06/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Humans and animals may be exposed to increasing contaminant lithium (Li) concentrations in the environment with the use and disposal of Li-containing products. Meanwhile, Li plays a key role in the treatment of human mental disorders, while the excessive accumulation of Li salts in the body can cause renal damage and nephrotic syndrome. In this study, the mechanism of renal inflammatory reaction induced by Li excessive intake was studied by establishing mice models in vitro and in vivo. The results of histopathology staining and TdT-mediated dUTP nick-end labeling assay showed that high Li condition (Lithium carbonate, 20 mg/kg/twice a day, i.e., for 30 consecutive days) caused inflammatory damage and apoptosis in kidney tissue cells. Western blot, qPCR, and immunohistochemical analysis were used to further study. In the vivo experiments, we found that Li reduced antioxidant enzyme capacity (glutathione peroxidase, total superoxide dismutase, total antioxidant capacity, and catalase) and induced the production of reactive oxygen species (ROS). Moreover, excessive Li activated nuclear factor kappa-B (NF-κB) signaling pathway and nucleotide-binding oligomerization domain-like receptors domains-containing protein 3 (NLRP3) inflammasome, resulting in activation of inflammatory factors tumor necrosis factor-α and IL-1β in the kidney of mice. In the vitro study, ROS as an upstream signal phosphorylated IκBα and NF-κB, up-regulated the NLRP3 inflammasome, increased caspase3, 6, 7, and 9 to exaggerate inflammation response, finally inducing pyroptosis in renal cells.
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Affiliation(s)
- Hongyuan Jing
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Fuhan Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
- College of Veterinary Medicine, Jilin University, Changchun, China
| | - Xue-Jiao Gao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
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Group A Streptococci-Associated Necrotizing Fasciitis following Cat Bite in an Immunocompromised Patient. Case Rep Crit Care 2017; 2017:3718360. [PMID: 29348946 PMCID: PMC5733867 DOI: 10.1155/2017/3718360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/27/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Necrotizing soft tissue infections are characterized clinically by fulminant tissue destruction, systemic signs of toxicity, and high mortality. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Mortality rate is very high and could be even higher in an immunocompromised host. We present a 57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy with painful swelling of the left hand following a cat bite that was diagnosed as having group A streptococcus pyogenes-associated necrotizing fasciitis. Treatment with ampicillin-sulbactam, Clindamycin, and surgical debridement was performed. In spite of all the adequate therapy she succumbed to death from streptococcal toxic shock and related complications after thirty-two days of treatment in intensive care unit. Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. Tissue infections in cat bite wounds are commonly caused by pathogenic bacterium known as Pasteurella multocida. Group A streptococcal infections are not reported following cat bites. A high index of suspicion must be maintained to suspect group A streptococcal associated necrotizing fasciitis following cat bites and an early medical and surgical intervention should be made for any best possible outcome.
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Chen Y, Zheng L, Liu W, Li H, Yu S, Chen Q, Pan B, Yu H, Yu R. Electrocardiographic changes caused by lithium intoxication in an elderly patient. SPRINGERPLUS 2016; 5:10. [PMID: 26759749 PMCID: PMC4700026 DOI: 10.1186/s40064-015-1602-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/09/2015] [Indexed: 11/29/2022]
Abstract
Lithium intoxication can cause serious cardiac toxicity and is associated with electrocardiogram (ECG) changes. This paper described a case of a 76-year-old man who was lithium intoxicated and showed a variety of ECG abnormalities including sinus bradycardia, rapid atrial fibrillation, second-degree atrioventricular block and T wave changes. We monitored his ECGs during the after 3 days consecutively. After hemodialysis, his ECG abnormalities partially eased along with his serum lithium concentration decreased.
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Affiliation(s)
- Yiping Chen
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Leilei Zheng
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Weibo Liu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Huichun Li
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Shaohua Yu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Qiaozhen Chen
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Bin Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Hualiang Yu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Risheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
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Decker BS, Goldfarb DS, Dargan PI, Friesen M, Gosselin S, Hoffman RS, Lavergne V, Nolin TD, Ghannoum M. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol 2015; 10:875-87. [PMID: 25583292 DOI: 10.2215/cjn.10021014] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li(+)] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of the [Li(+)] (1D). Extracorporeal treatment is suggested if the [Li(+)] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li(+)] to <1.0 mEq/L is >36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li(+)] is <1.0 mEq/L (1D). Extracorporeal treatments should be continued for a minimum of 6 hours if the [Li(+)] is not readily measurable (1D). Hemodialysis is the preferred extracorporeal treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity, patient's clinical status, and availability of extracorporeal treatments.
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Affiliation(s)
- Brian S Decker
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - David S Goldfarb
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Paul I Dargan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marjorie Friesen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sophie Gosselin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Robert S Hoffman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Valéry Lavergne
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Thomas D Nolin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marc Ghannoum
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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