Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorDECKER, Brian S.
dc.contributor.authorGOLDFARB, David S.
dc.contributor.authorDARGAN, Paul I.
dc.contributor.authorFRIESEN, Marjorie
dc.contributor.authorGOSSELIN, Sophie
dc.contributor.authorHOFFMAN, Robert S.
dc.contributor.authorLAVERGNE, Valery
dc.contributor.authorNOLIN, Thomas D.
dc.contributor.authorGHANNOUM, Marc
dc.contributor.groupauthorEXTRIP Workgrp
dc.contributor.groupauthorBURDMANN, Emmanuel A.
dc.date.accessioned2018-07-05T17:49:39Z
dc.date.available2018-07-05T17:49:39Z
dc.date.issued2015
dc.description.abstractThe 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 life- threatening 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.
dc.description.indexMEDLINE
dc.description.sponsorshipNational Institute of Diabetes and Digestive and Kidney Diseases
dc.description.sponsorshipNational Center for Advancing Translational Sciences
dc.identifier.citationCLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, v.10, n.5, p.875-887, 2015
dc.identifier.doi10.2215/CJN.10021014
dc.identifier.eissn1555-905X
dc.identifier.issn1555-9041
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/26858
dc.language.isoeng
dc.publisherAMER SOC NEPHROLOGY
dc.relation.ispartofClinical Journal of the American Society of Nephrology
dc.rightsrestrictedAccess
dc.rights.holderCopyright AMER SOC NEPHROLOGY
dc.subject.othercontinuous venovenous hemodialysis
dc.subject.otheracute-renal-failure
dc.subject.othersodium polystyrene sulfonate
dc.subject.otherhigh-flux hemodialysis
dc.subject.otherperitoneal-dialysis
dc.subject.otherclinical-manifestations
dc.subject.otherreplacement therapy
dc.subject.otheractivated-charcoal
dc.subject.otherself-intoxication
dc.subject.othertoxicity
dc.subject.wosUrology & Nephrology
dc.titleExtracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup
dc.typearticle
dc.type.categoryreview
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryisoca
hcfmusp.author.externalDECKER, Brian S.:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalGOLDFARB, David S.:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalDARGAN, Paul I.:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalFRIESEN, Marjorie:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalGOSSELIN, Sophie:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalHOFFMAN, Robert S.:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalLAVERGNE, Valery:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalNOLIN, Thomas D.:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.author.externalGHANNOUM, Marc:Verdun Hosp, Dept Nephrol, Verdun, PQ H4G 2A3, Canada
hcfmusp.citation.scopus122
hcfmusp.description.beginpage875
hcfmusp.description.endpage887
hcfmusp.description.issue5
hcfmusp.description.volume10
hcfmusp.origemWOS
hcfmusp.origem.pubmed25583292
hcfmusp.origem.scopus2-s2.0-84929116781
hcfmusp.origem.wosWOS:000354144900020
hcfmusp.publisher.cityWASHINGTON
hcfmusp.publisher.countryUSA
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