Type or paste a DOI name into the text box. This article is about lithium handbook of kidney transplantation 6th edition pdf a medication.
For more general information on lithium as an element, see Lithium. Lithium compounds, also known as lithium salts, are primarily used as a psychiatric medication. Common side effects include increased urination, shakiness of the hands, and increased thirst. In the nineteenth century, lithium was used in people who had gout, epilepsy, and cancer. Its use in the treatment of mental disorder began in 1948 by John Cade in Australia. Lithium is used primarily for bipolar disorder.
The required dosage is slightly less than the toxic level, requiring close monitoring of blood levels of lithium carbonate during treatment. Lithium is recommended for the treatment of schizophrenic disorders only after other antipsychotics have failed and it has limited effectiveness when used alone. The results of different clinical studies of the efficacy of combining Lithium with antipsychotic therapy for treating schizophrenic disorders have varied. High levels of naturally occurring lithium in drinking water have been associated with lower rates of suicide. Those who use lithium should receive regular serum level tests and should monitor thyroid and kidney function for abnormalities, as it interferes with the regulation of sodium and water levels in the body, and can cause dehydration. Dehydration, which is compounded by heat, can result in increasing lithium levels.
Lithium concentrations in whole blood, plasma, serum or urine may be measured using instrumental techniques as a guide to therapy, to confirm the diagnosis in potential poisoning victims or to assist in the forensic investigation in a case of fatal overdosage. Serum lithium concentrations are usually in the 0. Doses are adjusted to achieve plasma concentrations of 0. 12 hours after the preceding dose. EKG changes — usually benign changes in T waves. Extrapyramidal side effects — movement-related problems such as muscle rigidity, parkinsonism, dystonia, etc.
Hypothyroidism — a deficiency of thyroid hormone. Brugada syndrome — a potentially fatal abnormality in the electrical activity of the heart. Hypercalcaemia — elevated blood levels of calcium. Hypermagnesaemia — elevated blood levels of magnesium. Hyperparathyroidism — elevated blood levels of parathyroid hormone. Hyperthyroidism — elevated blood concentrations of thyroid hormones. Myasthenia gravis — an autoimmune condition where the body’s own defences attack the neuromuscular junction — the gap across which the nerves communicate with the muscles — leading to muscle weakness.
Albuminuria — protein in the urine, a sign of impaired kidney function. Decreased creatinine clearance — another sign of impaired kidney function. Nystagmus — involuntary eye movements that can interfere with vision. Oliguria — low urine output, although excess urine output is more likely. Sexual dysfunction including impotence, decreased libido, vaginal dryness, erectile dysfunction, etc. Weight gain may be a source of low self-esteem for the clinically depressed. In addition to tremors, lithium treatment appears to be a risk factor for development of parkinsonism symptoms, although the causal mechanism remains unknown.
Most side effects of lithium are dose-dependent. The lowest effective dose is used to limit the risk of side effects. Most patients treated with lithium carbonate show elevated thyroid stimulating hormone levels in response to injections of thyrotropin-releasing hormone. Because lithium competes with the receptors for the antidiuretic hormone in the kidney, it increases water output into the urine, a condition called nephrogenic diabetes insipidus. Lithium is a teratogen, causing birth defects in a small number of newborn babies. While it appears to be safe to use while breastfeeding a number of guidelines list it as a contraindication including the British National Formulary.
Dehydration in people taking lithium salts can be very hazardous, especially when combined with lithium-induced nephrogenic diabetes insipidus with polyuria. Another danger is that if the period of dehydration and diuresis has been prolonged, total body stores of sodium may actually be depleted, despite elevated plasma levels. Lithium has been associated with several forms of kidney injury. Lithium is mainly removed from the body through glomerular function, but some is then reabsorbed together with sodium through the proximal tubule. Its levels are therefore sensitive to water and electrolyte balance.
There are also drugs that can increase the clearance of lithium from the body, which can result in decreased lithium levels in the blood. These drugs include theophylline, caffeine, and acetazolamide. Lithium toxicity may occur on an acute basis, in persons taking excessive amounts either accidentally or intentionally, or on a chronic basis, in people who accumulate high levels during ongoing therapy. Overdosage, usually with plasma concentrations over 1. Lithium toxicity is compounded by sodium depletion. When toxic concentrations are reached, there may be a delay of one or two days before maximum toxicity occurs.