Significance of the serum lithium concentration and the treatment regimen for wanted and unwanted effects of lithium treatment

1983 ◽  
pp. 193-202
Author(s):  
Mogens Schou
Keyword(s):  
Treatment Regimen ◽  
Lithium Treatment ◽  
Lithium Concentration ◽  
Serum Lithium Concentration

scholarly journals NON PITTING TYPE PEDAL EDEMA WITH LITHIUM: A CASE REPORT

2016 ◽  
Vol 9 (1) ◽  
pp. 323
Author(s):  
Parvathypriya C. ◽  
Jeslyn Mary Philip ◽  
Christeena George ◽  
Lakshmi R.
Keyword(s):  
Affective Disorder ◽  
Dose Escalation ◽  
Lithium Treatment ◽  
Lithium Concentration ◽  
Bipolar Affective Disorder ◽  
Lithium Therapy ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Serum Lithium Concentration ◽  
Pedal Edema

<p><strong>Objective: </strong>To report a case of lithium induced bilateral nonpitting pedal edema.</p><p><strong>Methods: </strong>The clinical data of a bipolar affective disorder patient with current episode of mania and psychotic symptoms who experienced bilateral non pitting pedal edema with lithium.</p><p><strong>Results: </strong>The patient was a 29 yr old female who developed bilateral non-pitting type pedal edema with lithium therapy with normal plasma lithium level (0.72mEq/l). She is a known case of bipolar affective disorder (BPAD) was admitted to psychiatry department with episode of mania with psychotic symptoms. She had history of drug induced hypersensitivity reaction with eosinophilia and systemic symptoms (DRESS) with oxcarbazepine and so the drug was discontinued and was started on tablet lithium 400 mg twice daily. On admission here, the dose of lithium was increased to 1200 mg/day. The patient gradually improved but she developed bilateral non-pitting pedal edema. Serum lithium concentration was normal and there were no other early symptoms of lithium toxicity. But as the patient's distress further increased with increasing pedal edema, it was decided to stop lithium altogether and to maintain the patient on tablet quetiapine 800 mg therapy for BPAD. Within one week of stopping lithium the edema on both her feet decreased significantly. Causality was assessed by naranjo causality assessment scale and a probable relationship was obtained between lithium and pedal edema with a score of 6.</p><p><strong>Conclusion: </strong>This case emphasises that regular physical examination and laboratory investigations are important for patients who are on lithium therapy. Clinicians should always be careful while initiating lithium treatment in a patient with respect to the initial dose and dose escalation even after a period of successful therapy with lithium, as minor dose escalation can cause major changes in the serum lithium concentration and thereby the patient’s tolerability to lithium.</p>

Enhancement of hippocampal cholinergic neurotransmission through 5-HT1A receptor-mediated pathways by repeated lithium treatment in rats

2000 ◽  
Vol 78 (5) ◽  
pp. 392-399 ◽  
Author(s):  
Takeshi Fujii ◽  
Katsuhiko Nakai ◽  
Yasuo Nakajima ◽  
Koichiro Kawashima
Keyword(s):  
Binding Sites ◽  
Receptor Agonist ◽  
Lithium Treatment ◽  
Lithium Concentration ◽  
Receptor Function ◽  
Ach Release ◽  
Perfusion Fluid ◽  
Serum Lithium Concentration ◽  
Cholinergic Neurotransmission

Hippocampal cholinergic neuronal activity is reported to be regulated, at least partly, through serotonin1A (5-HT1A) receptors. Chronic lithium treatment has been shown to alter both behavioral and neurochemical responses mediated by postsynaptic 5-HT1A receptors. We investigated whether long-term lithium treatment affects central cholinergic neurotransmission through 5-HT1A receptor-mediated pathways. Changes in acetylcholine (ACh) release induced by 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a 5-HT1A receptor agonist, in the rat hippocampus were measured using a microdialysis technique and a radioimmunoassay for ACh. Administration of lithium for 21 days resulted in a serum lithium concentration of 1.03 mM and caused little change in density or affinity of [3H]8-OH-DPAT binding sites in the hippocampus. The local application of 8-OH-DPAT into the hippocampus of lithium treated rats increased the ACh efflux in both the absence and the presence of physostigmine, a cholinesterase (ChE) inhibitor, in the perfusion fluid. The basal ACh efflux of lithium treated rats was not different from that of the control rats under normal conditions, but was significantly higher than that of the controls when ChE was inhibited. These results demonstrate that chronic lithium treatment increases spontaneous ACh release in the hippocampus under conditions of ChE inhibition, but not under normal conditions, and enhances cholinergic neurotransmission through 5-HT1A receptor-mediated pathways, and suggest that activation of 5-HT1A receptor function by lithium is related to the enhancement of hippocampal cholinergic neurotransmission. Key words: Acetylcholine (ACh), hippocampus, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), lithium, serotonin1A (5-HT1A) receptor.

scholarly journals Stabilization of the Serum Lithium Concentration by Regulation of Sodium Chloride Intake: Case Report

2016 ◽  
Vol 136 (3) ◽  
pp. 517-521 ◽  
Author(s):  
Takashi Tomita ◽  
Hidekazu Goto ◽  
Kenji Sumiya ◽  
Tadashi Yoshida ◽  
Katsuya Tanaka ◽  
...  
Keyword(s):  
Case Report ◽  
Sodium Chloride ◽  
Lithium Concentration ◽  
Serum Lithium Concentration ◽  
Sodium Chloride Intake

scholarly journals Staying at the crossroads: assessment of the potential of serum lithium monitoring in predicting an ideal lithium dose

2008 ◽  
Vol 30 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Thiago Zaqueu Lima ◽  
Miriam Marcela Blanco ◽  
Jair Guilherme dos Santos Júnior ◽  
Carolina Tesone Coelho ◽  
Luiz Eugênio Mello
Keyword(s):  
Open Field ◽  
Lithium Chloride ◽  
Elevated Plus Maze ◽  
Lithium Concentration ◽  
Serum Lithium Concentration ◽  
Narrow Therapeutic Range ◽  
Plus Maze ◽  
Sufficient Precision ◽  
Lithium Dose ◽  
Plasmatic Concentration

OBJECTIVE: Lithium has been successfully employed to treat bipolar disorder for decades, and recently, was shown to attenuate the symptoms of other pathologies such as Alzheimer's disease, Down's syndrome, ischemic processes, and glutamate-mediated excitotoxicity. However, lithium's narrow therapeutic range limits its broader use. Therefore, the development of methods to better predict its dose becomes essential to an ideal therapy. METHOD: the performance of adult Wistar rats was evaluated at the open field and elevated plus maze after a six weeks treatment with chow supplemented with 0.255%, or 0.383% of lithium chloride, or normal feed. Thereafter, blood samples were collected to measure the serum lithium concentration. RESULTS: Animals fed with 0.255% lithium chloride supplemented chow presented a higher rearing frequency at the open field, and higher frequency of arms entrance at the elevated plus maze than animals fed with a 50% higher lithium dose presented. Nevertheless, both groups presented similar lithium plasmatic concentration. DISCUSSION: different behaviors induced by both lithium doses suggest that these animals had different lithium distribution in their brains that was not detected by lithium serum measurement. CONCLUSION: serum lithium concentration measurements do not seem to provide sufficient precision to support its use as predictive of behaviors.

Evaluation of serum lithium concentration determinations

1991 ◽  
Vol 48 (7) ◽  
pp. 1536-1537
Author(s):  
Deborah H. Schweyen ◽  
Michael C. Sporka ◽  
Thomas G. Burnakis
Keyword(s):  
Lithium Concentration ◽  
Serum Lithium Concentration

scholarly journals Serum Lithium Concentration Can Be Used to Assess Dietary Compliance in Adults

2004 ◽  
Vol 134 (11) ◽  
pp. 3133-3136 ◽  
Author(s):  
William T. Donahoo ◽  
Daniel H. Bessesen ◽  
Dana R. Higbee ◽  
Sian Lei ◽  
Gary K. Grunwald ◽  
...  
Keyword(s):  
Lithium Concentration ◽  
Dietary Compliance ◽  
Serum Lithium Concentration

Lithium Intoxication with Acute Renal Failure and Death

1988 ◽  
Vol 22 (9) ◽  
pp. 691-694 ◽  
Author(s):  
S. Rutherfoord Rose ◽  
Wendy Klein-Schwartz ◽  
Gary M. Oderda ◽  
Richard L. Gorman ◽  
Wesley W.H. Young
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Lithium Concentration ◽  
Gastrointestinal Symptoms ◽  
Lithium Carbonate ◽  
Cardiovascular Collapse ◽  
Lithium Intoxication ◽  
Serum Lithium Concentration ◽  
Acute Ingestion

A 65-year-old female presented with only gastrointestinal symptoms eight to ten hours after an acute ingestion of an unknown amount of lithium carbonate. The serum lithium concentration was 8.5 mEq/L. Forty-eight hours postingestion she developed acute renal failure, deteriorating mental status, and cardiovascular collapse. Despite both hemodialysis and peritoneal dialysis the patient died approximately four and one-half days after ingestion. A direct nephrotoxic effect of lithium is proposed.

scholarly journals Interference in Serum Lithium Estimation by Silica Clot Activator and Silicone Surfactant in ISE Principle: a Cross-Sectional Study

2017 ◽  
Vol 8 (2) ◽  
pp. 60-65 ◽  
Author(s):  
L Naznin ◽  
D Saha ◽  
S Sultana ◽  
MMK Sarkar
Keyword(s):  
Lithium Concentration ◽  
Colorimetric Method ◽  
Elevated Serum ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Serum Lithium Concentration ◽  
Silicone Surfactant ◽  
Significant Difference ◽  
Clot Activator

Serum lithium concentration is monitored to ensure patient's compliance and to avoid intoxication and thus it is a prerequisite for an individual's dose adjustment. An unavoidable error during lithium estimation in blood collected in 'red-top plastic vacutainer plus tube containing silica clot activator and silicone surfactant' by ISE appeared as a reality for a standard laboratory like AFIP. The error could not be detected even by proven internal and external QC. This cross-sectional study was carried out at AFIP Chemical Pathology Department from May' 2015 to July'2015 to find out the interference causing falsely elevated serum lithium concentration by ISE principle. Blood were collected from the 40 study subjects including 30 healthy volunteers, who never took Tab Lithium and 10 patients, who used to take Tab Lithium for bipolar mood disorder in both 'plain red-top plastic vacutainer tubes without additive' as well as 'plain red-top plastic vacutainer plus tube containing silica clot activator and silicone surfactant'. Lithium concentrations were estimated in both types of tubes by Ion-Selective Electrode (ISE) principle employing world class, USA manufactured analyzer NOVA-4 as well as by colorimetric method using Dade Dimension, Siemens. Serum lithium concentrations were undetectable for the 'lithium-free normal volunteers' in both types of tubes measured by colorimetry but in ISE principle it was undetectable when collected in plain test tube without additives but when collected in 'vacutainer plus tube containing silica clot activator and silicone surfactant' and measured by ISE technique, the mean serum lithium concentration was found to be 1.78 ±0.40 mmol/l. Besides, mean serum lithium concentration of 10 individuals taking Tab Lithium had no statistically significant difference while measured by ISE or colorimetry in 'vacutainer tubes without additive' and also in 'vacutainer plus tubes containing silica clot activator and silicone surfactant' measured by colorimetry. But, vacutainer plus tubes containing silica clot activator and silicone surfactant' while measured serum lithium concentration by ISE principle had significant (p <0.001) increase in mean concentration than others, as determined by one-way ANOVA and Post-hoc tests. This study demonstrates that positive interference; caused by silica clot activator and silicone surfactant of the collection tubes; increases measured concentration of lithium. This interference; being in the pre-analytic phase, cannot be detected by routinely performed laboratory quality control.Bangladesh J Med Biochem 2015; 8(2): 60-65

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