Aspects of the use of lithium for the non-psychiatrist

Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium

Lithium is frequently used in the management of several psychiatric disorders including acute mania, bipolar (manic-depressive) disorder, and recurrent depression. We describe a patient in whom hidradenitis suppurativa developed while the patient was receiving lithium. The cutaneous side effects of lithium are reviewed. The most frequent are psoriasis, acneiform lesions, folliculitis, alopecia, and a maculopapular/macular eruption. Many of these side effects respond less readily to conventional therapy while the patient is receiving lithium.

Acute and short-term effects of lithium on glutamate metabolism in rat brain

Amino acids of the glutamate family, viz. glutamic acid, aspartic acid, glutamine, gamma-amino-butyric acid (GABA) and alanine, along with the activities of glutamic acid dehydrogenase (GDH), aspartic acid aminotransferase (AST), alanine aminotransferase (ALT), glutamine synthetase (GS), glutaminase, glutamic acid decarboxylase (GAD) and GABA-aminotransferase (GABA-T) were estimated in cerebral cortex, cerebellum and brain stem of rats treated with a single dose of lithium or with seven daily doses of lithium (3 m-equiv./kg body wt). The levels of GABA were found to increase in cerebral cortex and brain stem following the administration of a single dose and also were found to be increased in cerebral cortex and cerebellum after treatment for 7 days. The content of glutamic acid was increased in all three brain regions after treatment for 7 days. Glutamine was increased in both cerebral cortex and brain stem after treatment for 7 days, whereas aspartic acid was increased in brain stem after both the administration of single dose and treatment for 7 days. A significant increase (P less than 0.05) in the activity of GS was observed in brain stem after 7 days of treatment. Similarly, a significant increase (P less than 0.01) in the activity of AST was observed in all three regions of the brain following the treatment for 7 days. The above results are discussed in relation to the known effects of lithium on brain cation metabolism and a suggestion is made that an imbalance in the functional activities of glutamic acid and GABA as a result of quantitative changes in these amino acids, brought about by lithium, may play a role in the therapeutic efficacy of lithium in bipolar disorders.

Toxicity and renal elimination of lithium in rats of different ages

In 5- and 15-day-old rats, acute toxicity is much higher than in adults. However, in young rats two sublethal doses of lithium (75% of the LD50) can be injected in a shorter time interval than in adults, resulting in the same mortality (50%). After pretreatment of rats with 1.15 meq Li+/100 g b.wt. daily for 2 days and a load of 0.3 meq Li+/100 g b.wt. intraperitoneally on the day on which diuresis experiments were performed, a distinct age-dependence in renal lithium elimination was observed, with age-dependent consequences for the elimination of sodium and potassium. In the postnatal period, the ability to excrete lithium matures earlier than the ability to eliminate sodium. Thus the age-dependence of lithium toxicity stems from the age-dependent pharmacokinetic parameters of lithium, such as distribution and renal elimination.