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

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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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Footnotes

  • For correspondence: Dr D N Juurlink, University of Toronto, Toronto, Ontario, Canada. david.juurlink{at}ices.on.ca

  • Sources of funding: Canadian Institutes of Health Research and Ontario Ministry of Health.