Clinical, laboratory and neurological assessment of lithium toxicity in patients with bipolar disorders
Main Article Content
Keywords
Bipolar disorder, lithium, toxicity, neurological symptoms
Abstract
Background: Lithium was once the drug of choice for treating bipolar disorder. It has a low therapeutic efficacy and frequently appears in hazardous concentrations in clinical practice. It has been found that long-term lithium intoxication, which is caused by lithium gradually building up, is more common. The overwhelming majority of the symptoms are neurological; commonly, the mental state is disturbed and could even become coma-like.
Aim: To measure the clinical, laboratory, and neurological changes of lithium toxicity in patients with bipolar disorder in correlation with these effects with periodic lithium level monitoring.
Methods: In order to pinpoint individuals with euthymic BD based on various serum concentrations (<1.2, 1.2-3, and >3 mmol/L), the cohort research was carried out in Al Azhar New Damietta Hospital from September 1, 2022 to the end of January 2023. Disease was confirmed using the Young Mania Rating Scaling (YMRS) and the structured diagnostic examination for DSM-V axis I disorders.
Demographic, clinical, and laboratory data were obtained for analysis.
Results: The distribution of severe/moderate/mild neurological symptoms for the >3 mmol/L, 1.2– 3 mmol/L and <1.2 mmol/L groups were 0/10/40, 10/15/10 and 20/0/0 % respectively (p< 0.05). Cardiovascular symptoms appeared more common in patients receiving >3 mmol/L of lithium than those receiving 1.2–3 mmol/L and <1.2 mmol/L of lithium level (10% versus 5 and 0%, respectively p < 0.05). The blood urea nitrogen, creatinine and TSH levels significantly increased in severe toxic lithium level (>3 mmol/L, p<0.05).
Conclusion: Participants receiving continuous lithium treatment should be closely watched for its toxicity and administered right away in the event of poisoning due to the outstanding results of detoxification programs.
References
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guidelines. Journal of affective disorders. 2017;217:266-80.
2. Volkmann C, Bschor T, Köhler S. Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry. 2020;11:377.
3. Köhler-Forsberg O, Rohde C, Nierenberg AA, Østergaard SD. Association of Lithium treatment with the risk of osteoporosis in patients with
bipolar disorder. JAMA psychiatry. 2022;79(5):454-63.
4. Luu B, Rodway G. Lithium therapy for bipolar disorder. The Journal for Nurse Practitioners. 2018;14(2):93-9.
5. Carvalho AF, Firth J, Vieta E. Bipolar disorder. New England Journal of Medicine. 2020;383(1):58-66.
6. Severus E, Bauer M, Geddes J. Efficacy and effectiveness of lithium in the long-term treatment of bipolar disorders: An update 2018.
Pharmacopsychiatry. 2018;51(05):173-6.
7. Sani G, Perugi G, Tondo L. Treatment of bipolar disorder in a lifetime perspective: is lithium still the best choice? Clinical drug investigation.
2017;37:713-27.
8. Parker G, Graham R, Tavella G. Is there consensus across international evidence‐based guidelines for the management of bipolar
disorder? Acta Psychiatrica Scandinavica. 2017;135(6):515-26.
9. Öhlund L, Ott M, Oja S, Bergqvist M, Lundqvist R, Sandlund M, et al. Reasons for lithium discontinuation in men and women with bipolar
disorder: a retrospective cohort study. BMC psychiatry. 2018;18:1-10.
10. Won E, Kim Y-K. An oldie but goodie: lithium in the treatment of bipolar disorder through neuroprotective and neurotrophic mechanisms.
International journal of molecular sciences. 2017;18(12):2679.
11. Hermann A, Gorun A, Benudis A. Lithium use and non-use for pregnant and postpartum women with bipolar disorder. Current Psychiatry
Reports. 2019;21:1-10.
12. Gomes-da-Costa S, Marx W, Corponi F, Anmella G, Murru A, Pons-Cabrera MT, et al. Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2022;134:104266.
13. Woo YS, Yoon B-H, Song J-H, Seo JS, Nam B, Lee K, et al. Clinical correlates associated with the long-term response of bipolar disorder
patients to lithium, valproate or lamotrigine: A retrospective study. PLoS One. 2020;15(1):e0227217.
14. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and
International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders.
2018;20(2):97-170.
15. Kamal ZM, Dutta S, Rahman S, Etando A, Hasan E, Nahar SN, et al. Therapeutic Application of Lithium in Bipolar Disorders: A Brief Review.
Cureus. 2022;14(9).
16. Shulman KI, Almeida OP, Herrmann N, Schaffer A, Strejilevich SA, Paternoster C, et al. Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: an ISBD task force report. Bipolar Disorders. 2019;21(2):117-23.
17. Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, et al. GERI-BD: a randomized double-blind controlled trial of
lithium and divalproex in the treatment of mania in older patients with bipolar disorder. American Journal of Psychiatry. 2017;174(11):1086-93.
18. Scott J, Etain B, Bellivier F. Can an integrated science approach to precision medicine research improve lithium treatment in bipolar disorders? Frontiers in psychiatry. 2018;9:360.
19. Machado-Vieira R. Lithium, stress, and resilience in bipolar disorder: deciphering this key homeostatic synaptic plasticity regulator. Journal
of Affective Disorders. 2018;233:92-9.
20. Malhi GS, Bell E, Porter RJ, Boyce P, Mulder R, Hopwood M, et al. Lithium should be borne in mind: Five key reasons. SAGE Publications Sage UK: London, England; 2020. p. 659-63.
21. Sleem A, El-Mallakh RS. Advances in the psychopharmacotherapy of bipolar disorder type I. Expert Opinion on Pharmacotherapy.
2021;22(10):1267-90.
22. Janicak PG. Bipolar disorder in adults and lithium: Pharmacology, administration, and management of adverse effects. UpToDate
Waltham, MA: UpTo-Date. 2021.
23. Elsayed OH, Pahwa M, El-Mallakh RS. Pharmacologic treatment and management of bipolar disorder in adolescents. Expert Opinion
on Pharmacotherapy. 2022;23(10):1165-79.
24. Fornaro M, De Berardis D, Anastasia A, Novello S, Fusco A, Cattaneo CI, et al. The identification of biomarkers predicting acute and maintenance lithium treatment response in bipolar disorder: a plea for further research attention. Psychiatry Research. 2018;269:658-72.
25. Rybakowski JK, Ferensztajn-Rochowiak E. Mini-review: Anomalous association between lithium data and lithium use. Neuroscience Letters. 2022:136590.
26. First MB. Structured clinical interview for DSMIV axis I disorders. Biometrics Research Department. 1997.
27. Segal DL, Kabacoff RI, Hersen M, Van Hasselt VB, Ryan CF. Update on the reliability of diagnosis in older psychiatric outpatients using
the Structured Clinical Interview for DSM-III-R. Journal of Clinical Geropsychology. 1995;1(4):313-21.
28. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. The British journal of psychiatry.
1978;133(5):429-35.
29. Nolen WA, Weisler RH. The association of the effect of lithium in the maintenance treatment of bipolar disorder with lithium plasma levels: a post hoc analysis of a double‐blind study comparing switching to lithium or placebo in patients who responded to quetiapine (Trial 144). Bipolar disorders. 2013;15(1):100-9.
30. Prien RF, Caffey EM. Relationship between dosage and response to lithium prophylaxis in recurrent depression. The American Journal of
Psychiatry. 1976.
31. Johnson FN, Johnson S. Lithium in MedicalPractice: Proceedings of the First British Lithium Congress, University of Lancaster, England, 15-
19 July 1977: University Park Press; 1978.
32. Waters BG, Lapierre Y, Gagnon A, Cahudhry R, Tremblay A, Sarantidis D, et al. Determination of the optimal concentration of lithium for the
prophylaxis of manic-depressive disorder. Biological Psychiatry. 1982.
33. Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Australian & New Zealand Journal of
Psychiatry. 2001;35(6):833-40.
34. Vodovar D, El Balkhi S, Curis E, Deye N, Mégarbane B. Lithium poisoning in the intensive care unit: predictive factors of severity and
indications for extracorporeal toxin removal to improve outcome. Clinical Toxicology. 2016;54(8):615-23.
35. Okusa MD, Crystal LJT. Clinical manifestations and management of acute lithium intoxication. The American journal of medicine.
1994;97(4):383-9.
36. HANSEN HE, Amdisen A. Lithium intoxication: report of 23 cases and review of 100 cases from the literature. QJM: An International Journal of Medicine. 1978;47(2):123-44.
37. Dyson E, Simpson D, Prescott L, Proudfoot A. Self-poisoning and therapeutic intoxication with lithium. Human toxicology. 1987;6(4):325-9.
38. Gadallah M, Feinstein E, Massry S. Lithium intoxication: clinical course and therapeutic considerations. Mineral and electrolyte metabolism. 1988;14(2-3):146-9.
39. Bastiampillai T, Gupta A, Allison S, Chan SKW. NICE guidance: why not clozapine for treatmentrefractory bipolar disorder? The Lancet
Psychiatry. 2016;3(6):502-3.
40. Dineen R, Bogdanet D, Thompson D, Thompson C, Behan L, McKay A, et al. Endocrinopathies and renal outcomes in lithium therapy: impact of lithium toxicity. QJM: An International Journal of Medicine. 2017;110(12):821-7.
41. McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis.
The Lancet. 2012;379(9817):721-8.
42. Shine B, McKnight RF, Leaver L, Geddes JR. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis
of laboratory data. The Lancet. 2015;386(9992):461-8.
43. Le Roy V, Delmas Y, Verdoux H. Chronic renal complications induced by lithium. L'encephale. 2009;35(6):605-10.
44. Markowitz GS, Radhakrishnan J, Kambham N, Valeri AM, Hines WH, D'AGATI VD. Lithium nephrotoxicity: a progressive combined
glomerular and tubulointerstitial nephropathy. Journal of the American Society of Nephrology. 2000;11(8):1439-48.
45. Presne C, Fakhouri F, Noël L-H, Stengel B, Even C, Kreis H, et al. Lithium-induced nephropathy: rate of progression and prognostic factors.
Kidney international. 2003;64(2):585-92.
46. Christensen BM, Kim Y-H, Kwon T-H, Nielsen S. Lithium treatment induces a marked proliferation of primarily principal cells in rat kidney inner medullary collecting duct. American Journal of Physiology-Renal Physiology. 2006.
47. Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC public health.
2008;8(1):1-13.
48. Bassilios N, Martel P, Godard V, Froissart M, Grünfeld J-P, Stengel B. Monitoring of glomerular filtration rate in lithium-treated outpatients—an ambulatory laboratory database surveillance. Nephrology Dialysis Transplantation. 2008;23(2):562-5.
49. Clos S, Rauchhaus P, Severn A, Cochrane L, Donnan PT. Long-term effect of lithium maintenance therapy on estimated glomerular
filtration rate in patients with affective disorders: a population-based cohort study. The Lancet Psychiatry. 2015;2(12):1075-83.
50. Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clinical neuropharmacology. 2005;28(1):38-49.
51. Cohen WJ, Cohen NH. Lithium carbonate, haloperidol, and irreversible brain damage. Jama. 1974;230(9):1283-7.
52. Waring W, Laing W, Good A, Bateman D. Pattern of lithium exposure predicts poisoning severity: evaluation of referrals to a regional
poisons unit. Journal of the Association of Physicians. 2007;100(5):271-6.
53. Grandjean EM, Aubry J-M. Lithium: Updated human knowledge using an evidence-based approach: Part II: Clinical pharmacology and
therapeutic monitoring. CNS drugs. 2009;23:331-49.
54. Lazarus JH. Lithium and thyroid. Best practice & research Clinical endocrinology & metabolism. 2009;23(6):723-33.
55. Williams J, Berens S, Wolff J. Thyroid secretion in vitro: inhibition of TSH and dibutyryl cyclicAMP stimulated 131I release by Li+. Endocrinology. 1971;88(6):1385-8.
56. Haden ST, Stoll AL, McCormick S, Scott J, ElHajj Fuleihan G. Alterations in parathyroid dynamics in lithium-treated subjects. The Journal
of Clinical Endocrinology & Metabolism. 1997;82(9):2844-8.
57. Bendz H, Sjödin I, Toss G, Berglund K. Hyperparathyroidism and long‐term lithium therapy–a cross‐sectional study and the effect of
lithium withdrawal. Journal of internal medicine. 1996;240(6):357-65.
58. El Khoury A, Petterson U, Kallner G, ÅbergWistedt A, Stain-Malmgren R. Calciumhomeostasis in long-term lithium-treated women
with bipolar affective disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2002;26(6):1063-9.
59. Khandwala HM, Van Uum S. Reversible hypercalcemia and hyperparathyroidism associated with lithium therapy: case report and
review of literature. Endocrine Practice. 2006;12(1):54-8.
60. Wermers RA, Khosla S, Atkinson EJ, Hodgson SF, O'Fallon WM, Melton III LJ. The rise and fallof primary hyperparathyroidism: a populationbased study in Rochester, Minnesota, 1965-1992. Annals of Internal Medicine. 1997;126(6):433-40.
61. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clinical endocrinology.
2009;71(4):485-93.
62. Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? Journal of affective
disorders. 2013;146(2):151-7.
63. Nordenström J, Elvius M, Bågedahl-Strindlund M, Zhao B, Törring O. Biochemical hyperparathyroidism and bone mineral status in
patients treated long-term with lithium. Metabolism. 1994;43(12):1563-7.
64. Kallner G, Petterson U. Renal, thyroid and parathyroid function during lithium treatment: laboratory tests in 207 people treated for 1–30
years. Acta Psychiatrica Scandinavica. 1995;91(1):48-51.
guidelines. Journal of affective disorders. 2017;217:266-80.
2. Volkmann C, Bschor T, Köhler S. Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry. 2020;11:377.
3. Köhler-Forsberg O, Rohde C, Nierenberg AA, Østergaard SD. Association of Lithium treatment with the risk of osteoporosis in patients with
bipolar disorder. JAMA psychiatry. 2022;79(5):454-63.
4. Luu B, Rodway G. Lithium therapy for bipolar disorder. The Journal for Nurse Practitioners. 2018;14(2):93-9.
5. Carvalho AF, Firth J, Vieta E. Bipolar disorder. New England Journal of Medicine. 2020;383(1):58-66.
6. Severus E, Bauer M, Geddes J. Efficacy and effectiveness of lithium in the long-term treatment of bipolar disorders: An update 2018.
Pharmacopsychiatry. 2018;51(05):173-6.
7. Sani G, Perugi G, Tondo L. Treatment of bipolar disorder in a lifetime perspective: is lithium still the best choice? Clinical drug investigation.
2017;37:713-27.
8. Parker G, Graham R, Tavella G. Is there consensus across international evidence‐based guidelines for the management of bipolar
disorder? Acta Psychiatrica Scandinavica. 2017;135(6):515-26.
9. Öhlund L, Ott M, Oja S, Bergqvist M, Lundqvist R, Sandlund M, et al. Reasons for lithium discontinuation in men and women with bipolar
disorder: a retrospective cohort study. BMC psychiatry. 2018;18:1-10.
10. Won E, Kim Y-K. An oldie but goodie: lithium in the treatment of bipolar disorder through neuroprotective and neurotrophic mechanisms.
International journal of molecular sciences. 2017;18(12):2679.
11. Hermann A, Gorun A, Benudis A. Lithium use and non-use for pregnant and postpartum women with bipolar disorder. Current Psychiatry
Reports. 2019;21:1-10.
12. Gomes-da-Costa S, Marx W, Corponi F, Anmella G, Murru A, Pons-Cabrera MT, et al. Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2022;134:104266.
13. Woo YS, Yoon B-H, Song J-H, Seo JS, Nam B, Lee K, et al. Clinical correlates associated with the long-term response of bipolar disorder
patients to lithium, valproate or lamotrigine: A retrospective study. PLoS One. 2020;15(1):e0227217.
14. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and
International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders.
2018;20(2):97-170.
15. Kamal ZM, Dutta S, Rahman S, Etando A, Hasan E, Nahar SN, et al. Therapeutic Application of Lithium in Bipolar Disorders: A Brief Review.
Cureus. 2022;14(9).
16. Shulman KI, Almeida OP, Herrmann N, Schaffer A, Strejilevich SA, Paternoster C, et al. Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: an ISBD task force report. Bipolar Disorders. 2019;21(2):117-23.
17. Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, et al. GERI-BD: a randomized double-blind controlled trial of
lithium and divalproex in the treatment of mania in older patients with bipolar disorder. American Journal of Psychiatry. 2017;174(11):1086-93.
18. Scott J, Etain B, Bellivier F. Can an integrated science approach to precision medicine research improve lithium treatment in bipolar disorders? Frontiers in psychiatry. 2018;9:360.
19. Machado-Vieira R. Lithium, stress, and resilience in bipolar disorder: deciphering this key homeostatic synaptic plasticity regulator. Journal
of Affective Disorders. 2018;233:92-9.
20. Malhi GS, Bell E, Porter RJ, Boyce P, Mulder R, Hopwood M, et al. Lithium should be borne in mind: Five key reasons. SAGE Publications Sage UK: London, England; 2020. p. 659-63.
21. Sleem A, El-Mallakh RS. Advances in the psychopharmacotherapy of bipolar disorder type I. Expert Opinion on Pharmacotherapy.
2021;22(10):1267-90.
22. Janicak PG. Bipolar disorder in adults and lithium: Pharmacology, administration, and management of adverse effects. UpToDate
Waltham, MA: UpTo-Date. 2021.
23. Elsayed OH, Pahwa M, El-Mallakh RS. Pharmacologic treatment and management of bipolar disorder in adolescents. Expert Opinion
on Pharmacotherapy. 2022;23(10):1165-79.
24. Fornaro M, De Berardis D, Anastasia A, Novello S, Fusco A, Cattaneo CI, et al. The identification of biomarkers predicting acute and maintenance lithium treatment response in bipolar disorder: a plea for further research attention. Psychiatry Research. 2018;269:658-72.
25. Rybakowski JK, Ferensztajn-Rochowiak E. Mini-review: Anomalous association between lithium data and lithium use. Neuroscience Letters. 2022:136590.
26. First MB. Structured clinical interview for DSMIV axis I disorders. Biometrics Research Department. 1997.
27. Segal DL, Kabacoff RI, Hersen M, Van Hasselt VB, Ryan CF. Update on the reliability of diagnosis in older psychiatric outpatients using
the Structured Clinical Interview for DSM-III-R. Journal of Clinical Geropsychology. 1995;1(4):313-21.
28. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. The British journal of psychiatry.
1978;133(5):429-35.
29. Nolen WA, Weisler RH. The association of the effect of lithium in the maintenance treatment of bipolar disorder with lithium plasma levels: a post hoc analysis of a double‐blind study comparing switching to lithium or placebo in patients who responded to quetiapine (Trial 144). Bipolar disorders. 2013;15(1):100-9.
30. Prien RF, Caffey EM. Relationship between dosage and response to lithium prophylaxis in recurrent depression. The American Journal of
Psychiatry. 1976.
31. Johnson FN, Johnson S. Lithium in MedicalPractice: Proceedings of the First British Lithium Congress, University of Lancaster, England, 15-
19 July 1977: University Park Press; 1978.
32. Waters BG, Lapierre Y, Gagnon A, Cahudhry R, Tremblay A, Sarantidis D, et al. Determination of the optimal concentration of lithium for the
prophylaxis of manic-depressive disorder. Biological Psychiatry. 1982.
33. Oakley PW, Whyte IM, Carter GL. Lithium toxicity: an iatrogenic problem in susceptible individuals. Australian & New Zealand Journal of
Psychiatry. 2001;35(6):833-40.
34. Vodovar D, El Balkhi S, Curis E, Deye N, Mégarbane B. Lithium poisoning in the intensive care unit: predictive factors of severity and
indications for extracorporeal toxin removal to improve outcome. Clinical Toxicology. 2016;54(8):615-23.
35. Okusa MD, Crystal LJT. Clinical manifestations and management of acute lithium intoxication. The American journal of medicine.
1994;97(4):383-9.
36. HANSEN HE, Amdisen A. Lithium intoxication: report of 23 cases and review of 100 cases from the literature. QJM: An International Journal of Medicine. 1978;47(2):123-44.
37. Dyson E, Simpson D, Prescott L, Proudfoot A. Self-poisoning and therapeutic intoxication with lithium. Human toxicology. 1987;6(4):325-9.
38. Gadallah M, Feinstein E, Massry S. Lithium intoxication: clinical course and therapeutic considerations. Mineral and electrolyte metabolism. 1988;14(2-3):146-9.
39. Bastiampillai T, Gupta A, Allison S, Chan SKW. NICE guidance: why not clozapine for treatmentrefractory bipolar disorder? The Lancet
Psychiatry. 2016;3(6):502-3.
40. Dineen R, Bogdanet D, Thompson D, Thompson C, Behan L, McKay A, et al. Endocrinopathies and renal outcomes in lithium therapy: impact of lithium toxicity. QJM: An International Journal of Medicine. 2017;110(12):821-7.
41. McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis.
The Lancet. 2012;379(9817):721-8.
42. Shine B, McKnight RF, Leaver L, Geddes JR. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis
of laboratory data. The Lancet. 2015;386(9992):461-8.
43. Le Roy V, Delmas Y, Verdoux H. Chronic renal complications induced by lithium. L'encephale. 2009;35(6):605-10.
44. Markowitz GS, Radhakrishnan J, Kambham N, Valeri AM, Hines WH, D'AGATI VD. Lithium nephrotoxicity: a progressive combined
glomerular and tubulointerstitial nephropathy. Journal of the American Society of Nephrology. 2000;11(8):1439-48.
45. Presne C, Fakhouri F, Noël L-H, Stengel B, Even C, Kreis H, et al. Lithium-induced nephropathy: rate of progression and prognostic factors.
Kidney international. 2003;64(2):585-92.
46. Christensen BM, Kim Y-H, Kwon T-H, Nielsen S. Lithium treatment induces a marked proliferation of primarily principal cells in rat kidney inner medullary collecting duct. American Journal of Physiology-Renal Physiology. 2006.
47. Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC public health.
2008;8(1):1-13.
48. Bassilios N, Martel P, Godard V, Froissart M, Grünfeld J-P, Stengel B. Monitoring of glomerular filtration rate in lithium-treated outpatients—an ambulatory laboratory database surveillance. Nephrology Dialysis Transplantation. 2008;23(2):562-5.
49. Clos S, Rauchhaus P, Severn A, Cochrane L, Donnan PT. Long-term effect of lithium maintenance therapy on estimated glomerular
filtration rate in patients with affective disorders: a population-based cohort study. The Lancet Psychiatry. 2015;2(12):1075-83.
50. Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clinical neuropharmacology. 2005;28(1):38-49.
51. Cohen WJ, Cohen NH. Lithium carbonate, haloperidol, and irreversible brain damage. Jama. 1974;230(9):1283-7.
52. Waring W, Laing W, Good A, Bateman D. Pattern of lithium exposure predicts poisoning severity: evaluation of referrals to a regional
poisons unit. Journal of the Association of Physicians. 2007;100(5):271-6.
53. Grandjean EM, Aubry J-M. Lithium: Updated human knowledge using an evidence-based approach: Part II: Clinical pharmacology and
therapeutic monitoring. CNS drugs. 2009;23:331-49.
54. Lazarus JH. Lithium and thyroid. Best practice & research Clinical endocrinology & metabolism. 2009;23(6):723-33.
55. Williams J, Berens S, Wolff J. Thyroid secretion in vitro: inhibition of TSH and dibutyryl cyclicAMP stimulated 131I release by Li+. Endocrinology. 1971;88(6):1385-8.
56. Haden ST, Stoll AL, McCormick S, Scott J, ElHajj Fuleihan G. Alterations in parathyroid dynamics in lithium-treated subjects. The Journal
of Clinical Endocrinology & Metabolism. 1997;82(9):2844-8.
57. Bendz H, Sjödin I, Toss G, Berglund K. Hyperparathyroidism and long‐term lithium therapy–a cross‐sectional study and the effect of
lithium withdrawal. Journal of internal medicine. 1996;240(6):357-65.
58. El Khoury A, Petterson U, Kallner G, ÅbergWistedt A, Stain-Malmgren R. Calciumhomeostasis in long-term lithium-treated women
with bipolar affective disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2002;26(6):1063-9.
59. Khandwala HM, Van Uum S. Reversible hypercalcemia and hyperparathyroidism associated with lithium therapy: case report and
review of literature. Endocrine Practice. 2006;12(1):54-8.
60. Wermers RA, Khosla S, Atkinson EJ, Hodgson SF, O'Fallon WM, Melton III LJ. The rise and fallof primary hyperparathyroidism: a populationbased study in Rochester, Minnesota, 1965-1992. Annals of Internal Medicine. 1997;126(6):433-40.
61. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clinical endocrinology.
2009;71(4):485-93.
62. Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? Journal of affective
disorders. 2013;146(2):151-7.
63. Nordenström J, Elvius M, Bågedahl-Strindlund M, Zhao B, Törring O. Biochemical hyperparathyroidism and bone mineral status in
patients treated long-term with lithium. Metabolism. 1994;43(12):1563-7.
64. Kallner G, Petterson U. Renal, thyroid and parathyroid function during lithium treatment: laboratory tests in 207 people treated for 1–30
years. Acta Psychiatrica Scandinavica. 1995;91(1):48-51.
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Mar 26, 2023
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El-sayed Hamdey El-sayed Gawesh, Samir Atef Farid Elmetwally, Ahmed Ibrahim Elshoura, Mokhtar Ahmed Mokhtar Abo-Elfotoh, Medhat Mohamed Abdelsalam Darwish, Shaymaa Mohammed Arafa, Ismail Sadek, Doaa Ibrahim Hassan Ibrahim, Aisha Ghanem Abd El Lateef, Mona M. Amin, Maryam Mohammed Mohammed Hamouda, Hanan Ahmed Abd Almohymen ALfiky, & Rehab Mohamed El shahat. (2023). Clinical, laboratory and neurological assessment of lithium toxicity in patients with bipolar disorders. Journal of Population Therapeutics and Clinical Pharmacology, 30(4), 379-391. https://doi.org/10.47750/jptcp.2023.30.04.037
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El-sayed Hamdey El-sayed Gawesh, Samir Atef Farid Elmetwally, Ahmed Ibrahim Elshoura, Mokhtar Ahmed Mokhtar Abo-Elfotoh, Medhat Mohamed Abdelsalam Darwish, Shaymaa Mohammed Arafa, Ismail Sadek, Doaa Ibrahim Hassan Ibrahim, Aisha Ghanem Abd El Lateef, Mona M. Amin, Maryam Mohammed Mohammed Hamouda, Hanan Ahmed Abd Almohymen ALfiky, & Rehab Mohamed El shahat. (2023). Clinical, laboratory and neurological assessment of lithium toxicity in patients with bipolar disorders. Journal of Population Therapeutics and Clinical Pharmacology, 30(4), 379-391. https://doi.org/10.47750/jptcp.2023.30.04.037