TY - JOUR

T1 - Lithium induced hypercalcemia

T2 - an expert opinion and management algorithm

AU - Kovacs, Zoltan

AU - Vestergaard, Peter

AU - W. Licht, Rasmus

AU - P. V. Straszek, Sune

AU - Hansen, Anne Sofie

AU - H. Young, Allan

AU - Duffy, Anne

AU - Müller-Oerlinghausen, Bruno

AU - Seemueller, Florian

AU - Sani, Gabriele

AU - Rubakowski, Janusz

AU - Priller, Josef

AU - Vedel Kessing, Lars

AU - Tondo, Leonardo

AU - Alda, Martin

AU - Manchia, Mirko

AU - Grof, Paul

AU - Ritter, Phillip

AU - Hajek, Tomas

AU - Lewitzka, Ute

AU - Bergink, Veerle

AU - Bauer, Michael

AU - Nielsen, René Ernst

N1 - Publisher Copyright: © 2022, The Author(s).

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - Affective disorder

KW - Bipolar disorder

KW - Lithium

KW - Side-effects

U2 - 10.1186/s40345-022-00283-3

DO - 10.1186/s40345-022-00283-3

M3 - Journal article

C2 - 36547749

AN - SCOPUS:85144864981

VL - 10

JO - International Journal of Bipolar Disorders

JF - International Journal of Bipolar Disorders

SN - 2194-7511

IS - 1

M1 - 34

ER -