Hemodialysis followed by continuous hemofiltration for treatment of lithium intoxication in children

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
R J MeyerT E Bunchman

Abstract

Hemodialysis is the usual recommended treatment for severe lithium intoxication; however, rebound of lithium levels may require repeated hemodialysis treatments. We proposed that the addition of continuous hemofiltration after hemodialysis would prevent rebound by providing ongoing clearance of lithium. We report two pediatric patients with lithium intoxication treated by hemodialysis followed by continuous venovenous hemofiltration with dialysis (CVVHD). Both patients were symptomatic at presentation and had initial lithium levels more than three times the usual therapeutic range. Hemodialysis followed by CVVHD resulted in rapid resolution of symptoms, followed by continuous clearance of lithium without requiring repeated hemodialysis sessions. Both patients had return of normal mental status during CVVHD treatment, and neither patient experienced complications of hemodialysis or CVVHD. Total duration of treatment with hemodialysis followed by CVVHD was 34.5 hours for the first patient and 26 hours for the second patient. We conclude that hemodialysis followed by CVVHD is a safe and effective approach to the management of lithium intoxication in children.

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Citations

May 17, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Scott WaltersPatrick D Brophy
Oct 13, 2010·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Timothy E Bunchman, Maria E Ferris
Jun 9, 2014·Current Hypertension Reports·Rossana Baracco, Tej K Mattoo
Mar 24, 2005·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Joseph T Flynn
Oct 8, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Joseph T Flynn, Kjell Tullus
Jan 25, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Janis M DionneJoseph T Flynn
Jul 21, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Jayanthi Chandar, Gastón Zilleruelo
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