Renal Function and Plasma Aldosterone during Acute Lithium Intoxication

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Abstract
Studies on plasma aldosterone, total serum protein, electrolytes, osmolal concentrations in serum and urine, creatinine, Li and osmolal clearances were carried out on 14 patients suffering from Li intoxication [Li salts are frequently used as psychotropic drugs]. The determinations were done on samples obtained on admission and during the following 12 days of treatment with hemodialysis, NaCl loading or forced diuresis. Plasma aldosterone and total serum protein were increased; serum Na concentrations and creatinine clearances were decreased on admission. Serum osmolality was normal; urine osmolal concentration was just above that in plasma. Li intoxicated patients were moderately depleted of Na and H2O on admission. Plasma aldosterone total serum protein and serum Na were normalized during treatment. Creatinine clearance increased but did not normalize in all patients. Renal concentrating tests were performed in 5 patients 3-4 wk after Li intoxication. The renal concentrating ability was reduced in all. The elevated plasma aldosterone seen in Li intoxication might have been a result of Na and H2O depletion. Impaired renal concentrating ability induced by Li may make some patients more susceptible to conditions which can lead to Na and H2O loss, and thereby to Li intoxication.