Blood Purification in Toxicology:Reviewing the Evidence and Providing Recommendations
Lithium
General Recommendations
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ECTR is recommended in patients with severe Li poisoning (1D)
Indications
ECTR is recommended
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If kidney function is impaired and the [Li+] > 4.0 mEq/L (1D)
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In the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of [Li+] (1D)
ECTR is suggested
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if the [Li+] > 5.0 mEq/L (2D)
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If confusion is present (2D)
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If the expected time to obtain a [Li+] < 1.0 mEq/L with optimal management is >36 h (2D)
Cessation of ECTR
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When the [Li+] < 1.0 mEq/L or clinical improvement is apparent (1D)
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After a minimum of 6 h of ECTR if the [Li+] is not readily available (1D)
After interruption of ECTR, serial [Li+] measurements should be obtained over 12 h to determine use of subsequent ECTR sessions (1D)
Choice of ECTR
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Intermittent hemodialysis is the preferred ECTR (1D)
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Continuous RRT is an acceptable alternative if intermittent hemodialysis is not available (1D)
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After initial treatment, both continuous RRT and intermittent hemodialysis are equally acceptable (1D)