scholarly journals Undetectable serum lithium concentrations after coadministration of liquid lithium citrate and apple juice: A case report

2021 ◽  
Vol 11 (1) ◽  
pp. 27-30
Author(s):  
Sundus Awan ◽  
Audrey Abelleira ◽  
Loveleen Khehra ◽  
Robin Hieber
Keyword(s):  
Apple Juice ◽  
Lithium Concentration ◽  
Oral Solution ◽  
Liquid Lithium ◽  
Serum Lithium Concentration ◽  
Undetectable Serum ◽  
Lithium Citrate ◽  
History Of ◽  
Bipolar Type ◽  
Inpatient Psychiatric Unit

Abstract Lithium is a mood-stabilizing medication approved by the FDA for the treatment of acute manic or mixed episodes of bipolar disorder as well as maintenance treatment. Lithium citrate is an oral solution, and the carbonate salt is available as oral capsules or extended-release tablets. A patient with a psychiatric history of PTSD and schizoaffective disorder–bipolar type, maintained on lithium and olanzapine prior to admission, was admitted to an inpatient psychiatric unit due to destabilization, paranoia, and mania. He was started on lithium citrate, administered with apple juice, while admitted due to nonadherence. An initial serum lithium concentration was found to be undetectable. Lithium was then administered with an alternative non–apple juice liquid, at which point serum lithium concentration became detectable and patient clinically improved. Lithium concentrations may be impacted by a number of causes, such as underlying medical conditions, drug interactions, and diet. As the majority of these factors remained stable during the patient's admission and the serum lithium concentration became detectable after switching from apple juice to an alternative non–apple juice liquid, it led to the identification of a possible incompatibility.

Stutter Exacerbated by Lithium in a Pediatric Patient with Bipolar Disorder

2011 ◽  
Vol 45 (10) ◽  
pp. 1310-1310 ◽  
Author(s):  
Brian C Gulack ◽  
Neil V Puri ◽  
Wun J Kim
Keyword(s):  
Bipolar Disorder ◽  
Pediatric Patient ◽  
Lithium Concentration ◽  
Serum Lithium Concentration ◽  
Hyperactivity Disorder ◽  
Not Otherwise Specified ◽  
History Of ◽  
Developmental Stuttering ◽  
Higher Doses ◽  
Lithium Dose

Objective: To report the first known case of a lithium-exacerbated stutter in a pediatric patient. Case Summary: A 10-year-old male with a history of developmental stuttering, bipolar disorder not otherwise specified (NOS), attention-deficit/hyperactivity disorder, and conduct disorder was admitted to the psychiatric hospital because of recurrent suicidal ideations and increased physical aggression toward staff at his residential facility. The patient was being treated with lithium at initial dose of 150 mg/day at bedtime for bipolar disorder NOS. When the lithium dose was increased to 900 mg twice daily to better control the bipolar symptoms, his developmental stutter worsened intensely. When the lithium dose was reduced to 60 mg in the morning and 900 mg at night, the stutter returned to baseline. No other medication changes were made during this interval. His serum lithium concentration was 0.62 mEq/L at baseline, 1.24 mEq/L during the height of his exacerbated stutter, and returned to 0.64 mEq/L after dose reduction. Discussion: To our knowledge, only 1 case lithium-exacerbated stutter has been reported to the literature, and this was in an adult. The developmental stutter of our pediatric patient worsened when he was treated with higher doses of lithium. He was on stable doses of his other medications during the adjustments to the lithium dose, malding it less likely that the stutter was due to one of these medications. However, it is possible that the exacerbation involved an interaction between lithium and one or several of the other medications. Based on the Naranjo probability scale, this case represents a probable adverse drug reaction. Conclusions: Clinicians should be aware that an additional adverse effect of lithium may be an exacerbation of stutter.

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.

Risk-Taking Propensity, Depression and Parasuicide

1976 ◽  
Vol 10 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Bruce Spittles ◽  
Ken Bragan ◽  
Basil James
Keyword(s):  
Risk Taking ◽  
Suicide Attempts ◽  
Psychological Adaptation ◽  
Psychiatric Unit ◽  
Depressed Patients ◽  
History Of ◽  
The Relationship ◽  
Inpatient Psychiatric Unit

One hundred patients admitted consecutively to an inpatient psychiatric unit were given questionnaires to measure risk-taking propensity and depression. The purpose was to study the relationship between risk-taking, depression, and recent suicide attempts. It was found that depressed patients showed a bimodal clustering towards the extremes of risk-taking. There was a history of suicide attempts only when a certain threshold of risk-taking was exceeded. These findings are discussed with relation to defensive styles of psychological adaptation and to arousal thresholds.

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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