Whole-bowel irrigation as a treatment for acute lithium overdose

Study objective: To determine if gastrointestinal decontamination using whole-bowel irrigation (WBI) was an effective treatment for acute ingestion of sustained-release lithium. Methods: In a two-phase, crossover protocol, ten normal volunteers ingested in each phase 0.80 mEq/kg sustained-release lithium carbonate. In the second phase, WBI was begun one hour after lithium ingestion, and 10 L of polyethylene glycol solution were administered over five hours. Serum samples were collected every half hour for six hours, every hour for an additional six hours, and then every 24 hours for as long as 72 hours after ingestion. These samples were analyzed for lithium concentration. The area under the lithium serum concentration-versus-time curve was calculated for each phase. Results: The average area under the lithium serum concentration-versus-time curve in the WBI phase was 67% ± 11% less than that in the control phase (P < .0005 using a two-tailed Student's t test). The mean serum lithium concentration was significantly decreased (P = .03) within one hour of beginning WBI. Conclusion: WBI is an effective treatment for acute ingestion of sustained-release lithium. We recommend it as the decontaminant procedure of choice in this situation.