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Lithium induced hypercalcemia: an expert opinion and management algorithm

Z. Kovacs, P. Vestergaard, R. W Licht, S. P V Straszek, AS. Hansen, A. H Young, A. Duffy, B. Müller-Oerlinghausen, F. Seemueller, G. Sani, J. Rubakowski, J. Priller, L. Vedel Kessing, L. Tondo, M. Alda, M. Manchia, P. Grof, P. Ritter, T. Hajek,...

. 2022 ; 10 (1) : 34. [pub] 20221222

Status not-indexed Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc22030996

BACKGROUND: Lithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking. METHODS: Based on a narrative review of the effects of lithium on calcium and parathyroid hormone (PTH) homeostasis and its clinical implications, experts developed a step-by-step algorithm to guide the initial management of emergent hypercalcemia during lithium treatment. RESULTS: In the event of albumin-corrected plasma calcium levels above the upper limit, PTH and calcium levels should be measured after two weeks. Measurement of PTH and calcium levels should preferably be repeated after one month in case of normal or high PTH level, and after one week in case of low PTH level, independently of calcium levels. Calcium levels above 2.8 mmol/l may require a more acute approach. If PTH and calcium levels are normalized, repeated measurements are suggested after six months. In case of persistent PTH and calcium abnormalities, referral to an endocrinologist is suggested since further examination may be needed. CONCLUSIONS: Standardized consensus driven management may diminish the potential risk of clinicians avoiding the use of lithium because of uncertainties about managing side-effects and consequently hindering some patients from receiving an optimal treatment.

Charité Universitätsmedizin Berlin and DZNE 10117 Berlin Germany

Copenhagen Affective Disorder Research Center Psychiatric Center Copenhagen Copenhagen Denmark

Department of Adult Psychiatry Poznan University of Medical Sciences Poznan Poland

Department of Clinical Medicine Aalborg University Aalborg Denmark

Department of Endocrinology Aalborg University Hospital Aalborg Denmark

Department of Medicine University of Copenhagen Copenhagen Denmark

Department of Neuroscience Section of Psychiatry Università Cattolica del Sacro Cuore Rome Italy

Department of Pharmacology Dalhousie University Halifax NS Canada

Department of Psychiatry and Psychotherapy University Hospital Carl Gustav Carus TU Dresden Dresden Germany

Department of Psychiatry Dalhousie University Halifax Canada

Department of Psychiatry Erasmus Medical Center Rotterdam The Netherlands

Department of Psychiatry Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

Department of Psychiatry Icahn School of Medicine at Mount Sinai New York City NY USA

Department of Psychiatry Psychotherapy Psychosomatics and Neuropsychiatry Kbo Lech Mangfall Klinik Garmisch Partenkirchen Auenstr 6 82467 Garmisch Partenkirchen Germany

Department of Psychiatry Queen's University Kingston ON Canada

Department of Psychological Medicine Institute of Psychiatry Psychology and Neuroscience King's College London and South London and Maudsley NHS Foundation Trust Bethlem Royal Hospital Monks Orchard Road Beckenham Kent BR3 3BX UK

Institute of Psychiatry Psychology and Neuroscience King's College London UK

Medical Faculty Brandenburg Theodor Fontane Neuruppin Germany

Mood Disorder Centro Lucio Bini Cagliari Italy

Mood Disorders Center Ottawa ON Canada

National Institute of Mental Health Klecany Czech Republic

Psychiatry Research and Treatment Program for Bipolar Disorder Aalborg University Hospital Mølleparkvej 10 9000 Aalborg Denmark

Rome McLean Hospital Harvard Medical School Rome Italy

School of Medicine Department of Psychiatry and Psychotherapy Technical University of Munich 81675 Munich Germany

Section of Psychiatry Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy

Steno Diabetes Center North Jutland Aalborg Denmark

Unit of Clinical Psychiatry University Hospital Agency of Cagliari Cagliari Italy

University of Edinburgh and UK DRI Edinburgh EH16 4SB UK

University of Toronto Toronto ON Canada

References provided by Crossref.org

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$a Lithium induced hypercalcemia: an expert opinion and management algorithm / $c Z. Kovacs, P. Vestergaard, R. W Licht, S. P V Straszek, AS. Hansen, A. H Young, A. Duffy, B. Müller-Oerlinghausen, F. Seemueller, G. Sani, J. Rubakowski, J. Priller, L. Vedel Kessing, L. Tondo, M. Alda, M. Manchia, P. Grof, P. Ritter, T. Hajek, U. Lewitzka, V. Bergink, M. Bauer, RE. Nielsen
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