Comparison between Acetate and Bicarbonate Dialysis for the Treatment of Lithium Intoxication
作者:
Harold M. Szerlip,
Peter Heeger,
George M. Feldman,
期刊:
American Journal of Nephrology
(Karger Available online 1992)
卷期:
Volume 12,
issue 1-2
页码: 116-120
ISSN:0250-8095
年代: 1992
DOI:10.1159/000168430
出版商: S. Karger AG
关键词: Lithium intoxication;Hemodialysis;Acetate Bicarbonate
数据来源: Karger
摘要:
Lithium is used to treat manic-depressive disorders, but toxic side effects commonly occur. The preferred treatment of severe lithium intoxication is hemodialysis. No data, however, exist comparing the effectiveness of acetate to bicarbonate dialysis for the removal of lithium. We present a case of lithium intoxication treated with both. During acetate dialysis, lithium removal occurred exclusively from the extracellular fluid space, while during bicarbonate dialysis, lithium removal occurred equally from both the extracellular and intracellular fluid spaces. We hypothesize that acetate but not bicarbonate activates the sodium-hydrogen antiporter on cell membranes, and that lithium, substituting for sodium, is driven into cells. This may explain the rebound in lithium levels commonly noted after conventional dialysis. We recommend bicarbonate hemodialysis as the therapy of choice for severe lithium intoxication.
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