Activated charcoal and sodium polystyrene sulfonate (Kayexalate®) in gastric decontamination for lithium intoxication: An animal model

Overdose with sustained-release lithium preparations

Two cases of overdose with sustained-release lithium preparations are presented. Initial serum lithium levels were in the therapeutic or subtherapeutic range. Subsequent levels were in the toxic range. These cases illustrate the potential danger of delayed toxicity with ingestion of these agents.

Lithium absorption prevented by sodium polystyrene sulfonate in volunteers

STUDY OBJECTIVE

To determine if sodium polystyrene sulfonate prevents absorption of lithium in human beings.

DESIGN

Prospective, crossover study.

TYPE OF PARTICIPANTS

Healthy volunteers age 22 to 34 years (three women and three men).

INTERVENTIONS

After an eight-hour fast, subjects ingested 0.5 mEq/kg (18.5 mg/kg) lithium carbonate. One hour later, they ingested either 857 mg/kg sodium polystyrene sulfonate in 4 mL water/g sodium polystyrene sulfonate (experimental) or an equal volume of water without sodium polystyrene sulfonate (control).

MEASUREMENTS AND MAIN RESULTS

Serum lithium levels were drawn zero, one, two, three, four, six, eight, ten, 12, and 24 hours after lithium ingestion. The sodium polystyrene sulfonate group had a smaller mean area under the serum concentration curve (11.6 +/- 1.0 mEq/L.hr versus 13.6 +/- 1.5 mEq/L.hr, P < .001) and lower mean highest measured lithium level (0.85 +/- 0.11 mEq/L versus 1.05 +/- 0.10 mEq/L, P < .05) compared with the control group. There was no significant difference in 24-hour urine lithium excretion or in serum sodium and potassium levels.

CONCLUSION

Sodium polystyrene sulfonate administration decreased absorption of lithium after a lithium carbonate overdose. Sodium polystyrene sulfonate may be useful clinically for gastric decontamination after lithium overdoses.