Document Type : Original Article
Authors
- Sara Zarei 1
- Maral Ramezani 2, 3
- Saeed Akbarzadeh Kolahi 4
- Shahin Shadnia 5
- Babak Mostafazadeh 5
- Peyman Erfan Talab Evini 5
- Mitra Rahimi 5
1 Tehran Medical Sciences Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University, Tehran, Iran
2 Department of Pharmacology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
3 Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
4 Department of Pharmacology and Toxicology, Tehran Medical Sciences Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University, Tehran, Iran
5 Toxicological Research Center, Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran
Abstract
Background: Lithium has been identified as a substance of significant toxicological concern, with the potential to inflict permanent damage to the central nervous system (CNS). This study examined cases of lithium poisoning over a period of ten years and compared them with cases from the previous decade.
Methods: This cross-sectional and retrospective study was conducted on patients with lithium poisoning. The study population comprised 491 patients. Information regarding the patients was retrieved from the hospital archives using a checklist. Subsequent to discharge, patients were monitored for post-operative outcomes. Subsequent to the completion of the study, a comparison was made between the results obtained and those from the previous decade.
Results: Among the 491 patients (mean age 33.6±15.1 years, 65% female) included in the study, 75.6% exhibited reduced systolic blood pressure. Lithium levels exhibited a substantial decrease following dialysis (p=0.016). The mortality rate was documented to be 1.6%. During subsequent follow-up, 0.4% of the subjects resumed lithium treatment, 1.8% attempted suicide, and 15.2% consulted a psychiatrist. It is noteworthy that cases of poisoning have increased fourfold over the past decade (P<0.001). Patients who consumed
more than 40 grams of the drug demonstrated a substantial decrease in the primary outcome (P=0.021). The proportion of hospitalizations lasting over two days decreased from 50% to 20.4% (P<0.0001).
Conclusion: The identification of lithium toxicity cases is facilitated by epidemiological data, thereby enabling a targeted management approach. A multifaceted approach is imperative to minimize toxicity risks. This approach should include the implementation of restricted re-prescription for suicidal use, stringent pharmacy controls, comprehensive family education on interactions, and regular renal monitoring.
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