Lithium toxicity profile: a systematic review and meta-analysis

医学 内科学 荟萃分析 锂(药物) 肾功能 安慰剂 优势比 不利影响 病理 替代医学
作者
Rebecca McKnight,Marc Adida,Katie Budge,Sarah Stockton,Guy M. Goodwin,John R. Geddes
出处
期刊:The Lancet [Elsevier BV]
卷期号:379 (9817): 721-728 被引量:617
标识
DOI:10.1016/s0140-6736(11)61516-x
摘要

Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects. We aimed to undertake a clinically informative, systematic toxicity profile of lithium.We undertook a systematic review and meta-analysis of randomised controlled trials and observational studies. We searched electronic databases, specialist journals, reference lists, textbooks, and conference abstracts. We used a hierarchy of evidence which considered randomised controlled trials, cohort studies, case-control studies, and case reports that included patients with mood disorders given lithium. Outcome measures were renal, thyroid, and parathyroid function; weight change; skin disorders; hair disorders; and teratogenicity.We screened 5988 abstracts for eligibility and included 385 studies in the analysis. On average, glomerular filtration rate was reduced by -6·22 mL/min (95% CI -14·65 to 2·20, p=0·148) and urinary concentrating ability by 15% of normal maximum (weighted mean difference -158·43 mOsm/kg, 95% CI -229·78 to -87·07, p<0·0001). Lithium might increase risk of renal failure, but the absolute risk was small (18 of 3369 [0·5%] patients received renal replacement therapy). The prevalence of clinical hypothyroidism was increased in patients taking lithium compared with those given placebo (odds ratio [OR] 5·78, 95% CI 2·00-16·67; p=0·001), and thyroid stimulating hormone was increased on average by 4·00 iU/mL (95% CI 3·90-4·10, p<0·0001). Lithium treatment was associated with increased blood calcium (+0·09 mmol/L, 95% CI 0·02-0·17, p=0·009), and parathyroid hormone (+7·32 pg/mL, 3·42-11·23, p<0·0001). Patients receiving lithium gained more weight than did those receiving placebo (OR 1·89, 1·27-2·82, p=0·002), but not those receiving olanzapine (0·32, 0·21-0·49, p<0·0001). We recorded no significant increased risk of congenital malformations, alopecia, or skin disorders.Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment.National Institute for Health Research Programme Grant for Applied Research.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
Simon完成签到 ,获得积分10
刚刚
枕安完成签到,获得积分10
1秒前
EliottLiu完成签到,获得积分10
1秒前
SciGPT应助聪慧的正豪采纳,获得10
2秒前
11发布了新的文献求助10
2秒前
2秒前
3秒前
lelelele完成签到,获得积分10
4秒前
4秒前
Jay完成签到,获得积分10
5秒前
FashionBoy应助笑点低诗桃采纳,获得10
6秒前
6秒前
青柠完成签到,获得积分10
7秒前
258369发布了新的文献求助10
9秒前
Ava应助俏皮的白柏采纳,获得10
10秒前
James- LPY发布了新的文献求助10
11秒前
千余发布了新的文献求助10
14秒前
anan完成签到,获得积分10
14秒前
17秒前
17秒前
18秒前
19秒前
莹0000完成签到,获得积分10
20秒前
21秒前
YamDaamCaa应助科研通管家采纳,获得30
22秒前
YamDaamCaa应助科研通管家采纳,获得30
23秒前
桐桐应助科研通管家采纳,获得10
23秒前
23秒前
烟花应助科研通管家采纳,获得10
23秒前
星辰大海应助科研通管家采纳,获得10
23秒前
23秒前
moon发布了新的文献求助10
23秒前
幽默尔蓝发布了新的文献求助10
23秒前
默默的裘完成签到,获得积分10
25秒前
科研通AI2S应助liuzengzhang666采纳,获得10
26秒前
深情安青应助lll采纳,获得10
27秒前
闪闪完成签到,获得积分10
28秒前
AST灰烬发布了新的文献求助10
28秒前
29秒前
鲤跃发布了新的文献求助10
31秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3988868
求助须知:如何正确求助?哪些是违规求助? 3531255
关于积分的说明 11253071
捐赠科研通 3269858
什么是DOI,文献DOI怎么找? 1804822
邀请新用户注册赠送积分活动 881994
科研通“疑难数据库(出版商)”最低求助积分说明 809035