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Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication

Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication Abstract • Two patients with life-threatening lithium carbonate intoxication (serum levels, >4 mEq/L [>4 mmol/L]) presented with a reduced or absent serum anion gap. In both subjects, hemodialysis simultaneously removed the excess lithium ion and normalized the anion gap. Conversely, the anion gap was normal in subjects with therapeutic serum lithium ion levels. Severe lithium carbonate intoxication should be added to the category of illnesses (multiple myeloma, bromide intoxication) causing a marked reduction in the anion gap. In the comatose patient, a reduced anion gap may serve as an important clinical clue to the presence of this drug intoxication. (Arch Intern Med 1986;146:1839-1840) References 1. Murray T, Long W, Narins RG: Multiple myeloma and the anion gap. N Engl J Med 1975;292:574-575.Crossref 2. Blume RS, MacLowry JD, Wolff SM: Limitations of chloride determination in the diagnosis of bromism. N Engl J Med 1968;279:593-595.Crossref 3. Emmett M, Narins RG: Clinical use of the anion gap. Medicine 1977;56:38-59.Crossref 4. Witte DL, Rodgers JL, Barrett DA III: The anion gap: Its use in quality control. Clin Chem 1976;22:643-650. 5. Thomas DW, Pain RW, Duncan BM: The anion gap. Lancet 1973;2:848849.Crossref 6. Van Slyke DD, Hastings AB, Hiller A, et al: Studies of gas and electrolyte equilibrium in the blood: XIV. The amount of alkali bound by serum albumin and globulin. J Biol Chem 1928;79:769-778. 7. Oh MS, Carroll HJ: The anion gap. N Engl J Med 1977;297:814-817.Crossref 8. Winchester JF: Lithium , in Haddad LM, Winchester JF (eds): Clinical Management of Poisoning and Drug Overdose . Philadelphia, WB Saunders Co, 1983, pp 372-379. 9. Hansen HE, Amidsen A: Lithium intoxication. Q J Med 1978;47:123-144. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication

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References (9)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360210237038
Publisher site
See Article on Publisher Site

Abstract

Abstract • Two patients with life-threatening lithium carbonate intoxication (serum levels, >4 mEq/L [>4 mmol/L]) presented with a reduced or absent serum anion gap. In both subjects, hemodialysis simultaneously removed the excess lithium ion and normalized the anion gap. Conversely, the anion gap was normal in subjects with therapeutic serum lithium ion levels. Severe lithium carbonate intoxication should be added to the category of illnesses (multiple myeloma, bromide intoxication) causing a marked reduction in the anion gap. In the comatose patient, a reduced anion gap may serve as an important clinical clue to the presence of this drug intoxication. (Arch Intern Med 1986;146:1839-1840) References 1. Murray T, Long W, Narins RG: Multiple myeloma and the anion gap. N Engl J Med 1975;292:574-575.Crossref 2. Blume RS, MacLowry JD, Wolff SM: Limitations of chloride determination in the diagnosis of bromism. N Engl J Med 1968;279:593-595.Crossref 3. Emmett M, Narins RG: Clinical use of the anion gap. Medicine 1977;56:38-59.Crossref 4. Witte DL, Rodgers JL, Barrett DA III: The anion gap: Its use in quality control. Clin Chem 1976;22:643-650. 5. Thomas DW, Pain RW, Duncan BM: The anion gap. Lancet 1973;2:848849.Crossref 6. Van Slyke DD, Hastings AB, Hiller A, et al: Studies of gas and electrolyte equilibrium in the blood: XIV. The amount of alkali bound by serum albumin and globulin. J Biol Chem 1928;79:769-778. 7. Oh MS, Carroll HJ: The anion gap. N Engl J Med 1977;297:814-817.Crossref 8. Winchester JF: Lithium , in Haddad LM, Winchester JF (eds): Clinical Management of Poisoning and Drug Overdose . Philadelphia, WB Saunders Co, 1983, pp 372-379. 9. Hansen HE, Amidsen A: Lithium intoxication. Q J Med 1978;47:123-144.

Journal

Archives of Internal Medicine – American Medical Association

Published: Sep 1, 1986

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