Loop diuretics and angiotensin converting enzyme inhibitors increased risk of hospital admission for lithium toxicity

doi:10.1136/ebm.10.1.28

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	EBM Aetiology

Evidence-Based Medicine 2005; 10:28
© 2005 BMJ Publishing Group Ltd.

Aetiology

Loop diuretics and angiotensin converting enzyme inhibitors increased risk of hospital admission for lithium toxicity

Juurlink DN, Mamdani MM, Kopp A, et al. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc 2004;52:794–8.[CrossRef][Medline]

Q In older persons, is use of diuretics, angiotensin converting enzyme (ACE) inhibitors, or non-steroidal anti-inflammatory drugs (NSAIDs) associated with hospital admission for lithium toxicity?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ ${star}$ ${star}$ ${star}$ Emergency Medicine $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Neurology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Geriatrics $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: diuretics • angiotensin-converting enzyme inhibitors • lithium

The first 150 words of the full text of this article appear below.

METHODS
Design: population based, nested, case control study with analysis ofmultiple linked healthcare databases over 10 years.

Setting: Ontario, Canada.

Patients: 10 615 patients $>=$ 66 years of age (mean age 72 y, 62% women) whowere receiving uninterrupted lithium treatment and resided inOntario, Canada.

Assessment of risk factors: use of diuretic (alone or in combination with another agent),ACE inhibitor, or prescription NSAID (including cyclooxygenase2 inhibitors). Thiazide type and loop diuretics were examinedseparately.

Outcome: hospital admission with diagnosis of lithium toxicity within28 days of exposure.

MAIN RESULTS
413 patients (3.9%) had $>=$ 1 hospital admission for lithium toxicity.After adjustment for potential confounders, patients treatedwith a loop diuretic or ACE inhibitor in the preceding 28 dayshad modest increased risk of hospital admission for lithiumtoxicity (table); these increased risks were particularly highamong patients newly treated with loop diuretics or ACE inhibitorsin the preceding 28 . . . [Full text of this article]

Maurice Laville, MD

Université Claude Bernard, Hôpital Edouard-Herriot
Lyon, Cedex, France