Lithium: a review of pharmacology, clinical uses, and toxicity.

A recent paper by McKnight et al. in The Lancet has provided the first formal meta-analysis of the more common adverse reactions to lithium. The authors analyzed 385 studies and focused mainly on the harmful effects of lithium on the kidney, the thyroid and parathyroid glands, body weight, skin and congenital malformations. Their contribution is important and welcome, but as a guide for practice, it needs to be complemented by other relevant observations and individual patient-focused perspectives. The findings from that meta-analysis somewhat underestimate the renal side-effects, and distort to some degree or exclude other adverse effects. The glomerular filtration rate is reduced but not more than 0 to 5 ml/min/year of observation; this may not fully reflect the present state of knowledge. A quarter of patients in the study had abnormalities of the thyroid and/or parathyroid gland, and lithium was found to increase body weight significantly less than did olanzapine. Unfortunately, the authors did not consider the observations from spontaneous reporting systems, which may have changed the picture. We feel that some specific limitations of the study were related to the inclusion of patients regardless of adequacy of treatment, quality of monitoring, drug combinations, age and sex, and stabilization response.

/pdf/commentary-on-a-recent-review-of-lithium-toxicity-what-are-3fv3wdjrbc.pdf

Commentary on a recent review of lithium toxicity: what are its implications for clinical practice?

Mental disorders in persons over 18 years of age are quite common and are represented by a fairly extensive list of diseases. In patients with a similar pathology, there is also a need for interventions and manipulations under conditions of anesthesia. The article presents the principles of perioperative management in patients with the most common mental illnesses — affective disorders, schizophrenia, bipolar disorder, anxiety disorders, behavioral syndromes associated with physiological disorders (bulimia, anorexia). Prevention of recurrence of mental illness and withdrawal synchroma, prevention of incidents associated with the intake of drugs used to treat psychopathology are reflected.

Perioperative management of patients with mental illness. Guidelines of the All-Russian Public Organization "Federation of Anesthesiologists and Reanimatologists"

http://www.raem.org.ar/numeros/2013-vol50/numero-02/107-126-endo2-1a.pdf

Tratamiento del hipertiroidismo por Enfermedad de Graves en pacientes adultos no embarazadas

https://www.psychiatrist.com/read-pdf/5035

Drs Aprahamian and Forlenza reply.

Lithium is widely used in the treatment of bipolar disorders. Long-term administration of lithium often leads to side effects concerning the subjects: nephrology, endocrinology and surgery. This review emphasizes nephrotoxicity.Lithium treatment may disturb responsiveness to antidiuretic hormone (ADH), causing a nephrogenic diabetes insipidus. Furthermore long-term lithium therapy may trigger hyperparathyreoidism with hypercalcemia and chronic interstitial nephritis with development of microcysts. Long-term patients have an increased risk to develop impaired renal function. Lithium-induced endstage renal disease is rare. Termination of lithium treatment may decrease the risk of progression.To ensure security of lithium treatment regular controls of urine osmolarity, lithium-, creatinine- , thyroid stimulating hormone- and calcium-levels are essential. Patients with decreased renal function should be referred to a specialist early.

[Renal side effects of long-term lithium therapy].

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[Renal side effects of long-term lithium therapy].