Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP workgroup

Brian S. Decker, David S. Goldfarb, Paul I. Dargan, Marjorie Friesen, Sophie Gosselin, Robert S. Hoffman, Valéry Lavergne, Thomas D. Nolin, Marc Ghannoum, Workgroup Extrip Workgroup, Kurt Anseeuw, Ashish Bhalla, Emmanuel A. Burdmann, Diane P. Calello, Paul I. Dargan, Brian S. Decker, Tais F. Galvao, David S. Goldfarb, Sophie Gosselin, Lotte C. HoegbergRobert S. Hoffman, David N. Juurlink, Jan T. Kielstein, Martin Laliberté, Valéry Lavergne, Kathleen D. Liu, Yi Li, Robert MacLaren, Robert Mactier, Bruno Mégarbane, James B. Mowry, Véronique Phan, Darren M. Roberts, Kevin M. Sowinski, Timothy J. Wiegand, James F. Winchester, Christopher Yates

Research output: Contribution to journalArticle

65 Scopus citations

Abstract

The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li+] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or lifethreatening dysrhythmias irrespective of the [Li+] (1D). Extracorporeal treatment is suggested if the [Li+] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li+] to <1.0 mEq/L is >36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li+] is <1.0 mEq/L (1D). Extracorporeal treatments should be continued for a minimum of 6 hours if the [Li+] is not readily measurable (1D). Hemodialysis is the preferred extracorporeal treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li+], kidney function, pattern of lithium toxicity, patient’s clinical status, and availability of extracorporeal treatments.

Original languageEnglish (US)
Pages (from-to)875-887
Number of pages13
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number5
DOIs
StatePublished - Jan 1 2015

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ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Decker, B. S., Goldfarb, D. S., Dargan, P. I., Friesen, M., Gosselin, S., Hoffman, R. S., Lavergne, V., Nolin, T. D., Ghannoum, M., Extrip Workgroup, W., Anseeuw, K., Bhalla, A., Burdmann, E. A., Calello, D. P., Dargan, P. I., Decker, B. S., Galvao, T. F., Goldfarb, D. S., Gosselin, S., ... Yates, C. (2015). Extracorporeal treatment for lithium poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clinical Journal of the American Society of Nephrology, 10(5), 875-887. https://doi.org/10.2215/CJN.10021014