All
lithium overdoses brought to the attention of the PCC were prospectively followed from January 1 to December 31, 1996. Patients for whom
hemodialysis was done were compared with those for whom it was recommended but not done in terms of clinical presentation,
lithium elimination half-life, need for transfer to another centre for
hemodialysis, and outcome (death, or sequel or recovery).
RESULTS: A total of 205 cases of
lithium overdoses were collected including 110 with levels higher than 1.5 mmol/l. There were 12 acute
lithium overdoses; no patients required
hemodialysis and there were no sequel or deaths. There were 174 acute on chronic overdoses;
hemodialysis was recommended in 9 patients but only 6 underwent
hemodialysis; one patient died during
hemodialysis but no other had sequel. There were 19 chronic
poisonings;
hemodialysis was recommended in 9 patients but only 2 had
hemodialysis, a third patient underwent
hemodialysis despite it not being recommended; one patient died without
hemodialysis and one other had sequel after
hemodialysis. No difference were observed between the groups for age, sex, type of
poisoning (acute on chronic/chronic), levels (initial/peak/6 hours/extrapolated at 30 hours), time of presentation post-ingestion, presence of co-ingestants, symptoms and signs, Hansen and Amdisen grade, initial
creatinine, time of recommendation to perform
hemodialysis (daytime or nighttime), need to transfer patients to another centre to perform
hemodialysis, and outcome. Patients with acute on chronic
poisoning that were not hemodialyzed had longer elimination half-life than those for whom
hemodialysis was done even before
hemodialysis was performed: 50.1 +/- 13.6 h (n = 3) versus 12.9 +/-12.1 (n = 3) (p = 0.007), respectively.
CONCLUSION: No difference was observed between patients for whom
hemodialysis was done and those for whom it was recommended by PCC but not done. Despite the death of one patient clearly associated with voluntary withholding
hemodialysis, sequel was not seen in that group. The indications for
hemodialysis in
lithium poisoning should be reconsidered to include only the more severe cases.