From the FDA Drug Label
In severe cases of lithium poisoning, the first and foremost goal of treatment consists of elimination of this ion from the patient ... Hemodialysis is an effective and rapid means of removing the ion from the severely toxic patient The specific indications for haemodialysis in lithium toxicity are:
- Severe cases of lithium poisoning
- Severely toxic patients 1
From the Research
Hemodialysis is indicated in lithium toxicity when patients have severe symptoms, very high lithium levels, or kidney dysfunction that prevents normal lithium clearance, as evidenced by the most recent study in 2022 2. The specific indications for hemodialysis in lithium toxicity include:
- Severe symptoms such as seizures, coma, or significant cardiac abnormalities
- Lithium levels above 4.0 mEq/L regardless of symptoms
- Lithium levels above 2.5 mEq/L with severe clinical manifestations
- Kidney dysfunction, including acute kidney injury or chronic kidney disease, which may require dialysis at lower lithium levels due to impaired elimination
- Failure of supportive care and standard treatments to improve the patient's clinical condition The procedure effectively removes lithium from the bloodstream because lithium is a small molecule with minimal protein binding and distributes primarily in the extracellular fluid, as noted in a study from 2009 3. Multiple dialysis sessions may be necessary due to the redistribution phenomenon, where lithium shifts from tissues back into the bloodstream after initial clearance, as observed in a study from 2001 4. Continuous renal replacement therapy may be considered as an alternative in hemodynamically unstable patients, though it removes lithium less efficiently than intermittent hemodialysis, as reported in a study from 2012 5. Early nephrology consultation is essential to determine the optimal timing and approach to dialysis in lithium toxicity, taking into account factors such as the patient's clinical condition, lithium levels, and kidney function, as discussed in a study from 1988 6.