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)