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Lithium Toxicity Profile: Systematic Review and Meta-analysis

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Lithium Toxicity Profile: Systematic Review and Meta-analysis

Post  Admin on Mon Jan 23, 2012 11:09 pm

Lithium Toxicity Profile: Systematic Review and Meta-analysis


The Lancet, Early Online Publication, 20 January 2012

Background:
Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects.

Methods:
Systematic review and meta-analysis of randomised controlled trials & observational studies was done.

Results:
On average, glomerular filtration rate was reduced by −6·22 mL/min (95% CI −14·65 to 2·20, p=0·148) and urinary concentrating ability by 15% of normal maximum (weighted mean difference −158·43 mOsm/kg, 95% CI −229·78 to −87·07, p<0·0001). Lithium might increase risk of renal failure, but the absolute risk was small (18 of 3369 [0·5%] patients received renal replacement therapy).

The prevalence of clinical hypothyroidism was increased in patients taking lithium compared with those given placebo (odds ratio [OR] 5·78, 95% CI 2·00—16·67; p=0·001), and thyroid stimulating hormone was increased on average by 4·00 iU/mL (95% CI 3·90—4·10, p<0·0001).

Lithium treatment was associated with increased blood calcium (+0·09 mmol/L, 95% CI 0·02—0·17, p=0·009), and parathyroid hormone (+7·32 pg/mL, 3·42—11·23, p<0·0001).

Patients receiving lithium gained more weight than did those receiving placebo (OR 1·89, 1·27—2·82, p=0·002), but not those receiving olanzapine (0·32, 0·21—0·49, p<0·0001).

We recorded no significant increased risk of congenital malformations, alopecia, or skin disorders.


Interpretation:
- Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain.
- There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low.
- The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy.
- Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment.

Source:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961516-X/abstract



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Re: Lithium Toxicity Profile: Systematic Review and Meta-analysis

Post  P450 on Thu Jan 26, 2012 8:31 pm

Great paper

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