HDCN Article Review/Hyperlink

Leblanc M, Raymond M, Bonnardeaux A, et al

Lithium poisoning treated by high-performance continuous arteriovenous and venovenous hemodiafiltration

Am J Kidney Dis (Mar) 27:365-372 1996

Leblanc et al evaluated the effectiveness of continuous renal replacement therapies to treat lithium intoxication. They report the use of continuous arteriovenous and venovenous hemodiafiltration in the treatment of four patients with acute and three patients with chronic lithium intoxication. The authors varied dialysate flow from 1 L/hr to 2 L/hr during CVVHD and maintained 4 L/hr for CAVHD. Blood flow rates ranged from 82 to 219 mL/min. Lithium clearance increased with blood flow and dialysate flow rates. Lithium blood levels decreased in all patients and no rebound was observed.

Comment: Management of lithium poisoning includes gastric emptying and fluid balance. Saline loading and forced diuresis are not recommended. Hemodialysis has been used successfully in cases of moderate to severe acute intoxication, if serum lithium concentrations exceed 3.5 mEq/L or when chronic toxicity causes symptoms. Although intermittent hemodialysis provides excellent lithium clearance, treatment needs to be prolonged and repeated because of intracellular lithium accumulation and rebound following dialysis. This report shows that continuous renal replacement therapy results in gradual and more complete removal of lithium. CAVHD and CVVHD create a persistent gradient between the intracellular and extracellular compartments over a longer period than intermittent dialysis. (George R. Aronoff, M.D., University of Louisville)