Treatment of severe lithium poisoning and dialysis-induced hypophosphatemia with phosphorus-enriched hemodialysis: a case report

摘要

Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as a result of the drug' s relatively slow equilibration across cellular membranes. Use of a conventional, phosphorus-free, bicarbonate-based dialysis solution in the course of a dialytic treatment may engender hypophosphatemia in these individuals. It has previously been shown that such dialysis-induced hypophosphatemia can be avoided by the use of a conventional dialysis solution that has been enriched with phosphorus. In the present report, we describe a markedly lithium-intoxicated patient who developed dialysis-induced hypophosphatemia as a result of having been dialyzed with a conventional, phosphorus-free dialysis solution. The hypophosphatemia was rectified by a subsequent dialysis session using a phosphorus-containing dialysis solution. Preliminary findings have previously been described.