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

https://doi.org/10.1136/ebm.10.1.28

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    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.
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 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 ★★★★★☆☆ IM/Ambulatory care ★★★★☆☆☆ Emergency Medicine ★★★★★☆☆ Neurology ★★★★★☆☆ Geriatrics ★★★★★☆☆

    METHODS

    Embedded ImageDesign:

    population based, nested, case control study with analysis of multiple linked healthcare databases over 10 years.

    Embedded ImageSetting:

    Ontario, Canada.

    Embedded ImagePatients:

    10 615 patients ⩾66 years of age (mean age 72 y, 62% women) who were receiving uninterrupted lithium treatment and resided in Ontario, Canada.

    Embedded ImageAssessment of risk factors:

    use of diuretic (alone or in combination with another agent), ACE inhibitor, or prescription NSAID (including cyclooxygenase 2 inhibitors). Thiazide type and loop diuretics were examined separately.

    Embedded ImageOutcome:

    hospital admission with diagnosis of lithium toxicity within 28 days …

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