Search PubMed⌕ Search

Biomedical subjects

A Amdisen

Publications and source records attributed to A Amdisen.

77 records · Page 5Linked to original sources
PubMedDate not supplied

Clinical features and management of lithium poisoning.

Lithium salts, in particular the carbonate and citrate, were formerly in widespread use, forming part of alkaline salt mixtures which were used for treatment of the many disorders belonging to the uric acid diathesis. Among these disorders were mania, depression, acute mania, acute melancholia and periodic depression. Satisfactory prophylactic effects on periodic depression were directly claimed. Daily doses of 3 to 26 mmol of lithium were recommended as standards. Only slight or moderate symptoms of poisoning were reported in a very few cases during the period in question (1860 to 1930), when the popularity of these lithium-containing prophylactic drugs with a favourable therapeutic index was at its peak. Lithium intoxication was not a serious clinical problem until 1949 when Cade introduced his fortuitously effective, but nevertheless high, dosage regimen which was continued until signs of recovery from mania appeared. For the maintenance dose, Cade in principle recommended, but seldom adhered to, 17 mmol/day. Chronic lithium intoxication starts insidiously with silent affliction of the kidneys followed by 'prodromal' symptoms, and when moderate severity has been reached, an accelerating renal vicious circle with decreasing kidney function is imminent. After this point the chronic intoxication resembles acute intoxication. Active detoxification at this, or an earlier stage, leaves the patient with a good chance of recovery. At a later stage, with the occurrence of oliguria, semi-coma or coma, and latent convulsive movement, recovery is less certain. There is no specific antidote for the toxic effects of lithium. Haemodialysis is the most effective treatment for acute lithium poisoning. For patients with impaired, or potentially impaired renal function, peritoneal dialysis may be an alternative, but less effective, treatment. Forced diuresis demands unimpaired renal function, and is little more effective than withdrawal of treatment, supplemented with correction of water and electrolyte balance. Sodium overloading is not recommended. Patients on lithium prophylaxis are treated on an outpatient basis. Prevention of intoxication depends on cooperation between patient and clinician, and possibly on the use of smaller, low risk dosages in most patients.

Humans↗
PubMedDate not supplied

Serum level monitoring and clinical pharmacokinetics of lithium.

Short-term antimanic therapy with lithium and relapse-repressive, so-called "prophylactic" long-term therapy with lithium, may present clinical problems which demand an understanding of two cardinal properties of this form of therapy--the need to individualise the dose and the recognition that successful therapy involves the use of near-toxic dosage. Therefore, treatment must be constantly supervised, not only by the physician but also primarily by the patient himself, especially to avoid the ever-present risk of intoxication. Results of 25 years' clinical experience and more recent knowledge of the clinical pharmacokinetics of the lithium ion have shown that a serum level standardised with regard to dosage schedule, a fixed interval between last intake and blood sampling, blood sampling at the same hour, and choice of tablet brand, must all be considered essential to adjust dosage and to correctly monitor treatment. Optimum use of the lithium ion as a psychotherapeutic drug and of the standardised 12 hour lithium serum concentration, presupposes that the pharmacokinetics of the lithium ion are well understood by the clinician.

Adult↗