ArticleFrontiers in toxicology2025
Medium cut-off membrane expanded hemodialysis for Lithium removal: a case report.
Article in Frontiers in toxicology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Lithium remains a first-line treatment for bipolar disorder, though its narrow therapeutic window poses a significant risk of toxicity. Severe intoxication can lead to neurologic, renal, gastrointestinal, and endocrine complications. Extracorporeal therapies are the mainstay in managing life-threatening cases, particularly when serum concentration exceed 4.0 mmol/L or when renal function is impaired. Intermittent hemodialysis (HD) is the recommended extracorporeal treatment due to lithium's low molecular weight and minimal protein binding. Expanded hemodialysis (HDx) with medium cut-off (MCO) membranes, designed to enhance solute clearance, may represent a promising alternative. Case Report: We present a case of acute lithium intoxication in a 48-year-old male with a history of recurrent suicidal behavior and chronic lithium therapy. The patient arrived at the emergency department in a deep coma (GCS 3), with a serum lithium concentration of 4.5 mmol/L and preserved renal function. He underwent two intermittent HDx sessions using a Theranova® TH-400 MCO membrane. Serum lithium concentration declined to 1.6 mmol/L after the first session and progressively to 0.1 mmol/L within 72 h. No treatment-related complications were observed. Conclusion: This case described the potential utility of HDx with the MCO membrane (Theranova® 400) in managing severe lithium poisoning, achieving effective and sustained drug clearance. While HDx-MCO may offer a viable alternative to conventional HD, especially in settings where enhanced solute removal is desirable, further studies are needed to determine its efficacy and clinical role in lithium toxicity management.
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