Hemodiafiltration for Intoxication with Lithium Unmasking Its Anti-Parkinsonian Effect

Letter to the Editor

J Fam Med. 2021; 8(1): 1237.

Hemodiafiltration for Intoxication with Lithium Unmasking Its Anti-Parkinsonian Effect

Josef Finsterer¹, Claudia Stöllberger²* and Rebekka Wlassits²

1Rudolfstiftung Hospital, and the Messerli Institute, Vienna, Austria

2Department of Cardiology and Intensive Care Medicine, Rudolfstiftung Hospital, Vienna, Austria

*Corresponding author: Josef Finsterer, Rudolfstiftung Hospital, and the Messerli Institute, Vienna, Austria, Europe

Received: November 11, 2020; Accepted: January 19, 2021; Published: January 26, 2021

Letter to the Editor

From lithium it is known that it exhibits an anti-Parkinson effect [1]. Accordingly, smokers develop less frequently Parkinson’s Disease (PD) than the non-smoking population [2]. This is because tobacco contains a significant amount of lithium [3]. The anti-PD effect of lithium is explained by increased autophagy and reduction of intracellular a-synuclein [3]. Lithium inhibits GSK-3ß and consequently increases the ß-catenine activity [4]. Development of a Parkinson crisis due to flushing out of lithium by Hemodiafiltration (HDF), as in the following case, has not been reported.

The patient is a 63 years male (height 180cm, weight 75kg) who was living with his mother in a retirement home and developed fever since 4 days prior to admission. His previous history was positive for psychosis, bipolar disorder, arterial hypertension, chronic renal failure, chronic obstructive pulmonary disease, diabetes, bilateral hydrocele, prostate hypertrophy, polyneuropathy, lithium intoxication, and hyperlipidemia. He had the diagnosis of a questionable extra-pyramidal syndrome but no anti-Parkinson medication. His home medication included aripiprazole (400 mg/ once every 30 d), biperiden (8 mg/d), midazolam (0.25 mg/d), lithium (900 mg/d), quetiapine (50 mg/d), trazodone (75 mg/d), nebivolol (2.5 mg/d), metformin (850 mg/d), simvastatin (20 mg/d), tamsulosin (0.4 mg/d), fenoterol with ipratropium-bromid, and tiotropium plus olodaterol.

On admission (hospital day-1 (hd1)) he was comatose, had spontaneous resting tremor, and arterial hypotension (80/40 mmHg). Blood tests revealed hypokaliemia, hypernatriemia, and renal insufficiency (Table 1). The swab test for SARS-CoV2 was negative. ECG showed AV-block-I, right bundle-branch-block, and QT-prolongation (501 ms). X-ray of the lung was normal. Clinical neurologic exam on hd2 revealed somnolence, pain upon maximal passive anteflexion of head, nuchal rigor, ptosis, ophthalmoparesis, spontaneous myocloni all over the body, mild rigor of all extremities, reduced tendon reflexes on the lower limbs, and clonus of the left lower leg (Table 1). Cerebral CT-scan was non-informative. He was treated with fluid substitution, cefuroxim, levetirazetam (LEV) (1000 mg/d), and discontinuation of all psychiatric medication.

Citation:Finsterer J, Stöllberger C and Wlassits R. Hemodiafiltration for Intoxication with Lithium Unmasking Its Anti-Parkinsonian Effect. J Fam Med. 2021; 8(1): 1237.