Dr Ramprasad K S, Dr K Jagadeesh, Dr. Chidananda K N, Dr ...

Copy and paste this link to your website, so they can see this document directly without any plugins.



Keywords

lithium, with, Lithium, mood, other, serum, renal, side, toxicity, effects, level, Chidananda, Lithium,, Medical, treatment, used, function, data, therapeutic, levels, Shivamogga, 2014, 2014;, from, 1-5., Ijppr.Human,, Citation:, therapy., chronic, supportive

Transcript

Human Journals
Ijppr.Human
November 2014 Vol.:1, Issue:4
© All rights are reserved by Dr. Chidananda K.N et al.
Lithium A Gold Standard Mood Stabilizer - Renal Failure A
Hindrance in Use
http://ijppr.humanjournals.com/
Keywords: Lithium, Alkali metal, Mood stabilization,
Renal function
ABSTRACT
Introduction: Lithium, lightest of all Alkali metals used
in Medical field since 19
th century. In Psychiatry, its use
started from 1949 for mood stabilization in people
having mood disorders. There are reports of side effects
with reference to renal function impairment occurring
sporadically. The current study is to document the side
effects of Lithium at our center (Mc Gann District and
Teaching Hospital, Shivamogga, Karnataka, India.) and
compare with other centers.
Objectives: To compare the side effects of Lithium,
particularly of renal function with other centers.
Methods: The published articles of Lithium induced
toxicity at different centers are collected and compared
with our data.
Results: There were no differences in the renal side
effect of lithium in our data and the side effect published
at other centers.
Conclusion: Most of the side effects of Lithium are
reversible. The Lithium levels are to be monitored
constantly if used for long periods of time. Further
multicentric data collection and comparison need to be
continued.
Dr Ramprasad K S
1
, Dr K Jagadeesh
2
, Dr.
Chidananda K N
3*
, Dr. Sreenivas P Revankar
4
1. Assistant Professor,Department Of Psychiatry,
Shivamogga Institute Of Medical Sciences,Shivamogga,
2. Professor And Head, Department Of Pharmacology,
Shivamogga Institute Of Medical Sciences, Shivamogga,
3... Postgraduate,Department Of Pharmacology, Shivamogga
Institute Of Medical Sciences,Shivamogga
4. Assistant Professor, Department Of Pharmacology,
Shivamogga Institute Of Medical Sciences, Shivamogga,
Submission: 14 October 2014
Accepted: 5 November 2014
Published: 25 November 2014
Citation: Chidananda K.N et al. Ijppr.Human, 2014; Vol. 1(4): 1-5.
2
INTRODUCTION
Lithium, first used in the treatment of Gout in 1940’s
1
. It was used in the treatment of
hypertension and withdrawn because of side effects. It has a narrow therapeutic index. In 1949
Cade
1
found its use in controlling the fluctuations of mood in patients suffering from mood
disorders. Mood disorders involves presence of depression or mania which are the two ends of
mood spectrum. Around 50-65% of them have either one or the other end of the spectrum in their
life time. To avoid this, mood stabilizers like lithium is used. Lithium has a good membrane
stabilization of neurons by modulating energy metabolism. It provides neuroprotection and
neuroplasticity
2
. There are different schools of thought to use mood stabilizers along with
antidepressants or antipsychotics in the first episode or further episodes. The first incidence of
lithium toxicity was reported three decades ago
3
.Renal diseases in the form of tubular acidosis,
chronic tubulointerstitial nephritis, glomerular nephritis and nephrotic syndrome are seen with
chronic use of lithium
4
.Histopathologically the presence of tubular cysts is highly characteristic
of lithium toxicity
5
.It results in decrease in urine concentrating ability
6
.Lithium modulates
phosphoinositol pathway in the pathogenesis of minimal change glomerulonephritis disease.
7
Neuropsychiatric symptoms like irregular coarse tremors, fascicular twitchings, rigid motor
agitation, muscular weakness, ataxia, sluggishness ,delirium are the features of lithium toxicity.
Nausea, vomiting, diarrhea, sinus bradycardia and hypotension are other side effects
9
. Severe
lithium intoxication results in seizures, stupor, coma and 10% risk of permanent neurological
damage. Important renal manifestations include puffiness of face, polyuria and nephropathy
10
.
Lithium induced reversible polyuria andimpairment of urine concentrating ability is due to
inhibition of ADH in distal nephron
11
.Therapeutic blood level of lithium has to be maintained
in range of 0.6-1.2 mEq/l. Lithium toxicity does not cause progressive renal insufficiency
12
.It
also induces hypothyroidism on chronic therapy. A regular monitoring of serum lithium and
serum Creatinine levels is to be done once in every six months to one year
13
. At our hospital a
patient came with a history of treatment withLithium 900mg/day in divided doses for 15 years,
for which he developed puffiness of face,decreased urine output and laboratory investigations
showing serum lithium level of 5meq/l and serum creatinine level of 3.56meq/l. Lithium was
stopped and hemodialysis was done with other supportive measures, it resulted in improvement
of renal function and serum creatinine level was reduced to 1.1meq/l, were as serum lithium
level was reduced to 2meq/l.
Citation: Chidananda K.N et al. Ijppr.Human, 2014; Vol. 1(4): 1-5.
3
MATERIAL AND METHODS
The data was collected from the available published articles and compared with our center data
INCLUSION CRITERIA
I) People suffering with Mood disorder on Lithium therapy
II) Both sex
III) All age
IV) Comorbid Medical illness not considered except renal failure
EXCLUSION CRITERIA
Patients who are in renal failure.
RESULTS
As the lithium was stopped and patient treated with haemodailysis and other supportive measures
there was significant improvement in the patient condition and the serum creatinine was reduced
to 1.1.meq/l were as serum lithium level was reduced to 2meq/l.
DISCUSSION
Lithium though a gold standard in mood stabilization is to be used cautiously as it has a narrow
therapeutic index. toxic effects are on kidney, thyroid, nervous system. The Lithium toxicity
usually wanes off with stoppage of drug. This was also seen in our patient as he responded well
with stoppage of drug and initiation of treatment with hemodialysis and other supportive
measures. The same is seen in other literatures from different centers. Lithium is a widely used
mood stabilizer with a dose of 600-1200mg/day in the therapeutic blood levels of 0.6-1.2meq/l.
The mortality rate is reported to be approximately 25% in acute over dose and 9% during chronic
therapy. A constant monitoring is needed for 1) Serum Lithium, 2)T3, T4, TSH , 3) Serum
Creatinine. The above tests are needed to ensure the compliance of patients. Lithium toxicity is
more when serum Lithium levels are >4meq/l. Acute lithium toxicity is managed with stoppage
of drug, hemodialysis, forced diuresis and other supportive measures.
Citation: Chidananda K.N et al. Ijppr.Human, 2014; Vol. 1(4): 1-5.
4
CONCLUSION
Lithium, an effective mood stabilizer has a narrow therapeutic index, hence mandates constant
supervision over its blood levels and side effects. The monitoring of serum lithium, renal
function test, complete hemogram, thyroid profile and observing for neuropsychiatric symptoms
is important in lithium therapy. Educating the patients about adverse effects of lithium therapy
and further multi center data collection and comparison is needed.
Citation: Chidananda K.N et al. Ijppr.Human, 2014; Vol. 1(4): 1-5.
5
REFERENCES
1. Ross J B, Franz I T. Goodman And Gillmann; Pharmacological Basis Of
Therapeutics;11
th edition;p 485-86.
2. Siegel et al; Goodman and Gillmann; Pharmacological Basis Of Therapeutics;11th
edition. p771-788.
3. Edgell P G, Peterfy G, Pentes E J Lithium toxicity Lancet 1970;1:p 415-416
4. Melkowitz G S, Radhakrishnan J, kambham n et al. Lithium nephrotoxicity: a
progressive combined glomerular & tubulointerstitial nephropathy. J Am socnephrol
2000;11:p1439-1448.
5. Consult kidney international 2008:73;233-237
6. Herbert M; Goodman And Gillmann; Pharmacological Basis Of Therapeutics;11th
edition;p.500
7. The lancet, vol379,issue 817 p721-728 25thfeb 2012
8. Tam V K, Green J, Schweiger et al. Nephrotic syndrome & renal insufficiency associated
with lithium therapy. Am J kidney dis 996;27:p715-720.
9. AMJ kidney dis 1996; 27:p715-720.
10. Pael B R, kaye W R, khan M y et al. aggravation of diabetic nephropathy by lithium: a
case report & review of literature Jclin psychiatry 1989: 50; p101-103.
11. Lasar S T, Tollafsen G, lithium therapy in therapeutic drug monitoring Post grad med
1984;75:p169-185.
12. Am psychiatry association. practical guidelines for treatment of patients with bipolar
disorder am j psychiatry 1994; 151(supplement 10 ; 1-36.).
13. Price L H, Edinger G R lithium in treatment of mood disorder. New Eng J Of Med
1994:331(9);p591-8

PDF Document reader online

This website is focused on providing document in readable format, online without need to install any type of software on your computer. If you are using thin client, or are not allowed to install document reader of particular type, this application may come in hand for you. Simply upload your document, and Docureader.top will transform it into readable format in a few seconds. Why choose Docureader.top?

  1. Unlimited sharing - you can upload document of any size. If we are able to convert it into readable format, you have it here - saved for later or immediate reading
  2. Cross-platform - no compromised when reading your document. We support most of modern browers without the need of installing any of external plugins. If your device can oper a browser - then you can read any document on it
  3. Simple uploading - no need to register. Just enter your email, title of document and select the file, we do the rest. Once the document is ready for you, you will receive automatic email from us.

Previous 10

Next 10