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[Neurological complications attributable to lithium: An update]. Rev Med Interne 2020; 42:120-126. [PMID: 33203541 DOI: 10.1016/j.revmed.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
Lithium intoxication may induce neurological complications, initially characterised by a conscience alteration and an encephalopathy clinical picture with a risk of death or sever long-term consequences. With an occurrence sometimes atypical and possibly without initial hyperlitemia, the diagnosis delay of these complications might be important. Moreover, no specific guidelines focused on these complications are available. The aim of this article is to propose an update on diagnosis and treatment of neurological complications attributable to lithium, as encephalopathy.
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 1: epidemiology, methodology and general overview. Biomarkers 2019; 25:9-19. [PMID: 31735069 DOI: 10.1080/1354750x.2019.1694994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable poisons and mixed intoxications are the most common causes. The aim of this article is to describe biomarkers for screening and diagnosis of acute intoxications in critically ill patients. For this purpose, a survey of the relevant literature was conducted, and guidelines, case reports, expert assessments, and scientific publications were reviewed. In critical care, it should always be attempted to identify and quantify the poison or toxin with the assistance of enzyme immunoassay (EIA), chromatography, and mass spectrometry techniques and this section is critically appraised in this publication. The principles for anion gap, osmol gap and lactate gap and their usage in intoxications is shown. Basic rules in test methodology and pre-analytics are reviewed. Biomarkers in general are presented in part one and biomarkers for specific intoxications including ethanol, paracetamol, cardiovascular drugs and many others are presented in part two of these publications.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Jamal T, Hennequin C, Gahoual R, Leyris A, Beaudeux JL, Baud FJ, Houzé P. Is Capillary Electrophoresis a New Tool to Monitor Acute Lithium Poisoning in Human?†. J Anal Toxicol 2019; 43:571-578. [PMID: 30877800 DOI: 10.1093/jat/bkz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/03/2019] [Accepted: 02/20/2019] [Indexed: 01/24/2023] Open
Abstract
A 38-year-old man was admitted in the intensive care unit (ICU) after supposed ingestion of 504 sustained-release tablets of Theralithe™ corresponding ~200 g of lithium carbonate. At the admission, ~19.5 h after ingestion, the patient was conscious with trembling limbs, intense thirst, profuse sweats and vomiting and lithium serum concentration was 14.2 mmol/L. Toxicological screenings performed in urine and serum, were negative. Patient was treated with continuous extrarenal epuration by continue veno-venous hemodiafiltration starting (CCVHDF) 24 h post-admission and was carried on until 64 h. After 11 days in ICU, the patient was dismissed to the service without sequelae, and transferred to a psychiatric unit. To follow lithium concentrations in serum, urines and dialysates, we developed a simple, rapid and reliable method by capillary zone electrophoresis (CZE). Separation was achieved in 7 min. The method was linear between 0.14 and 1.44 mmol/L for serum samples, and between 0.07 and to 1.44 mmol/L for urines and dialysates. Limits of quantification were 0.15 mmol/L and 0.07 mmol/L for serum and others fluids, respectively. Intra- and inter-day precisions expressed as CV were systematically inferior to 12.1% for serum and 8.2% for other fluids. Results obtained regarding precision, accuracy, recovery and stability were satisfying, with recoveries ranging from 91.0 to 102.0%. Serum, urine and dialysate samples were measured using CZE and flame photometry. We observed a strong correlation between both methods as assessed by linear regression and Bland-Altman analysis. For the intoxicated patient, the assay was successfully applied to serum, urine and dialysates to determine the amount of lithium present in circulation and excreted. Lithium amounts in dialysates were estimated to correspond to 89% of total lithium excreted during CCVHF session while urine excretion account only for 11%.
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Affiliation(s)
- Tsandni Jamal
- Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, rue de Sèvres, Paris, France
| | - Carole Hennequin
- Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, rue de Sèvres, Paris, France
| | - Rabah Gahoual
- Laboratoire de chimie analytique, Faculté de Pharmacie, Université Paris Descartes, 4 avenue de l'Observatoire, Paris, France.,Unité de Technologies Biologiques et Chimiques pour la Santé (UTCBS), Paris 5-CNRS UMR8258 Inserm U1022, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Annie Leyris
- Laboratoire de chimie analytique, Faculté de Pharmacie, Université Paris Descartes, 4 avenue de l'Observatoire, Paris, France
| | - Jean-Louis Beaudeux
- Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, rue de Sèvres, Paris, France
| | - Frédéric J Baud
- Assistance Publique - Hôpitaux de Paris, Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Centre hospitalo-universitaire Necker - Enfants Malades, 149 rue de Sèvres, Paris, Université Paris Descartes, France.,EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics - Hôpitaux Universitaires Cochin - Broca - Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
| | - Pascal Houzé
- Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, rue de Sèvres, Paris, France.,Laboratoire de chimie analytique, Faculté de Pharmacie, Université Paris Descartes, 4 avenue de l'Observatoire, Paris, France.,Unité de Technologies Biologiques et Chimiques pour la Santé (UTCBS), Paris 5-CNRS UMR8258 Inserm U1022, Faculté de Pharmacie, Université Paris Descartes, Paris, France
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