Lithium treatment in maintenance dialysis. Review of the literature and report of a new case on hemodialysis.

The literature on lithium treatment during chronic dialysis is reviewed and a new case presented. In a patient suffering from bipolar affective disorder, onset of hemodialysis precipitated a manic episode. Oral lithium, given in single postdialysis doses, was well-tolerated, effective, and easy to handle. During 19 months of constant dosing, 10.8 mEq after each dialysis maintained steady-state predialysis levels at 0.50-0.77 mEq/L. Steady-state levels of the published cases were plotted against the maintenance doses and the regression function through the origin was calculated. From this, it is concluded that the average maintenance dose (in mEq), which is 18 times the desired predialysis level (in mEq/L), might serve as a starting dose, provided predialysis levels are closely monitored and doses readjusted accordingly. Preliminary evidence suggests that one to two weeks of constant dosing are needed to achieve steady-state, but that months or even years are required to fully assess the long-term fluctuations in lithium levels.