ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO2033

Forced Saline Diuresis Successfully Treats Lithium Intoxication

Session Information

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

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


  • 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

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) .


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.


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.


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.


  • Clinical Revenue Support