Endocrinopathies and renal outcomes in lithium therapy: impact of lithium toxicity
| Autor: | Delia Bogdanet, V O'Keane, Rosemary Dineen, Mark Sherlock, C Wall, D Thompson, A P McKay, Gerard Boran, L. A. Behan, James Gibney, Christopher J. Thompson |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Hypercalcaemia Lithium (medication) 030209 endocrinology & metabolism Gastroenterology 03 medical and health sciences 0302 clinical medicine Therapeutic index Internal medicine medicine Humans 030212 general & internal medicine Renal Insufficiency Retrospective Studies business.industry Hyperparathyroidism Retrospective cohort study General Medicine Middle Aged medicine.disease Endocrinology Hypercalcemia Lithium Compounds Female Hypernatremia Bipolar and Related Disorders business Treatment-resistant depression Ireland Primary hyperparathyroidism Kidney disease medicine.drug Antipsychotic Agents |
| Zdroj: | QJM : monthly journal of the Association of Physicians. 110(12) |
| ISSN: | 1460-2393 |
| Popis: | Lithium is the mainstay of treatment for bipolar disorder, mania and an augmentation therapy in patients with treatment resistant depression. It has a narrow therapeutic index, with recognized adverse multi-system and endocrine side effects.To assess the impact of lithium therapy, in particular lithium toxicity, on the development of endocrine and renal disorders in a cohort of patients in a single tertiary referral centre in Ireland.A retrospective analysis was performed of the prevalence of lithium toxicity and renal, thyroid and parathyroid dysfunction in our study population.We collected laboratory data from the Clinical Chemistry department of the Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. Our study population included all patients who had at least one serum lithium measurement from January 1st 2000 to December 31st 2014 inclusive.A total of 580 patients were included in the study. Among our study group, 70 patients (12.1%) had 1 toxic lithium measurement (lithium level1.2 mmol/l). 27.8% (n 161) of patients developed stage 3 Chronic kidney Disease (CKD) or higher, which was commoner in those patients who developed toxic lithium levels (P 0.0001) and in those who developed hypernatraemia (P 0.0001). 16.2% of patients (n 94) had one serum sodium145 mmol/l during follow up. 60 patients(10.3%) had a TSH10 mU/l, while complete suppression of TSH (0.05 mU/l) was observed in 22 patients (3.8%) during follow-up. 4% (n 37) of the study population had ≥1 serum corrected calcium level2.55 mmol/l, and 4 patients had biochemical confirmation of primary hyperparathyroidism but PTH levels were only performed in 2.8% (n 16) of the studypopulation.Stage 3 CKD is common in patients receiving lithium therapy. Lithium toxicity is associated with CKD and hypernatraemia. Thyroid dysfunction and hypercalcaemia are common in patients receiving lithium therapy. Patients receiving lithium therapy require surveillance of renal, thyroid and bone biochemistry. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|