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Kidney Week

Abstract: PO2033

Forced Saline Diuresis Successfully Treats Lithium Intoxication

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • Khan, Sabiha M., UMASS/Baystate, Springfield, Massachusetts, United States
  • Hodgins, Spencer, UMASS/Baystate, Springfield, Massachusetts, United States
  • Landry, Daniel L., UMASS/Baystate, Springfield, Massachusetts, United States
  • Mulhern, Jeffrey, UMASS/Baystate, Springfield, Massachusetts, United States
  • Braden, Gregory Lee, UMASS/Baystate, Springfield, Massachusetts, United States

Group or Team Name

  • Kidney Care & Transplant Services of New England
Background

Forced 0.9% normal saline (NS) diuresis (FSD) is not advised by poison control centers for lithium intoxication (LI) but 2 papers in '71 & '78 showed 350 - 500 ml/hr of FSD treated LI at 4mEq/L successfully. We studied all pts with LI over 10 years with both acute( A) overdoses and chronic(C) LI to compare FSD in both groups to pts requiring hemodialysis (HD) .

Methods

We found 20 LI pts seen over 10 years. Our team uses NS at 200-500 ml/hr as FSD in pts w/o CHF. 9 pts had Acute overdoses of L & 5 had C LI due to reduced gfr, ACE drugs or NSAIDS. These 14 got FSD, 200-500 ml/hr until L was < 1 mEq/L. 6 pts needed HD due to severe toxicity ( seizures, coma, hypotension). We compared & show the mean +SEM values for peak L level mEq/L, GFR calculated by the Cockcroft-Gault equation, the rate of L decrease in mEq/hr, the normalized rate of L decrease in mEq/24 hr & time in hrs to reach a L level of 1.0 mEq/L amongst the 3 groups.

Results

The mean peak L levels were: FSD A LI ,2.8+0.2 ( range, 2.3-4), FSD C LI, 2.8+0.4 (range, 2-4.2), HD LI 3.5+ 0.4( range, 1.8-4.9). There were no differences in L levels. The mean GFR was: FSD ALI, 127+11, FSD C LI, 66+17, HD LI 142+7, p< .05 FSD C LI vs FSD ALI or HD LI. The GFR was significantly lower in the C LI pts.The hourly rate of L decrease in mEq/hr was: FSD A LI, 0.13+.03, FSD C LI, 0.05+.01, HD LI, 0.22+.04. There was no difference in the rate of L decrease in FSD A LI v HD LI but both were much faster than FSD C LI, p<.05. The mean 24 hour decrease (mEq/L) in L was: FSD A LI, 3.1+2.2, FSD C LI, 1.1+ 0.2, & HD LI, 5.3+ 1.6. p<.05 FSD C LI vs FSD A LI or HD LI. The time to L level of 1 mEq/L was: FSD A LI, 14.4+1.3 h, FSD C LI, 36+4.3 h, HD LI, 11.5+2.3 h due to rebound after HD. . There was no difference in the time to normal L between FSD A LI & HD & both were much faster than FSD C LI. Linear regression of the rate of L decrease compared to the hourly rate of NS in FSD A LI pts showed greater decreases in L level with greater rates of FSD , r =.82, p=,.006. No pt had a serum Na > 145 mEq/L.

Conclusion

FSD with NS at rates of 200-500 ml successfully treats A LI and rates of L reduction approximate those of HD for LI. C LI can be treated with FSD but the rates of L decrease are slower possibly due to lower GFRs in these pts.This is the first study in 40 years showing efficacy of FSD in LI.

Funding

  • Clinical Revenue Support