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Would you recommend CRRT instead of intermittent hemodialysis to prevent lithium rebound in a patient with lithium toxicity after an initial intermittent hemodialysis session?

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In patients with lithium toxicity and risk of rebound after an initial intermittent hemodialysis session, would you recommend transitioning to CRRT?

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4 Answers
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Nephrology · Rush Medical College
Answered on

I think the best way to approach any "overdose" of a drug that is dialyzable and may have a rebound is to start with hemodialysis and run it until you have achieved your desired response (drug level, improvement in some other parameter) and follow that with CRRT to manage any rebound. This is well s...

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Nephrology · University Of California San Francisco Medical Center At Parnassus
Answered on

There are multiple good ways of doing this. CRRT after intermittent hemo is one option. Daily or even more frequent dialysis is another option. SLED/PIRRT is yet another option. I think as long as we start lowering the lithium levels and monitoring them, it is going a long way towards fixing the pro...

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Nephrology · The University of Texas Health Science Center at San Antonio
Answered on

No. Rebound of lithium levels after an initial hemodialysis procedure can occur, and depends on the level of the patient's renal function, whether the lithium ingestion was acute or chronic, and the severity of the overdose. Rather than implementing prophylactic CRRT to prevent rebound, I follow lit...

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Nephrology · John H Stroger Jr Hospital of Cook County
Answered on

We had one patient with rebound levels, so we started CRRT. This was successful, and it avoided long HD sessions, which required major staffing adjustments.

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