Lithium metabolism

Nordenstrom J, Elvius M, Bagedahl-Strindlund M, Zhao B, Torring O. Biochemical hyperparathyroidism and bone mineral status in patients treated long-term with lithium. Metabolism 1994 43(12) 1563-7. 

Clinical conditions that affect lithium metabolism. 

Lithium metabolism and transport cannot be studied directly, because the lack of useful radioisotopes has limited the metabolic information available. Lithium has five isotopes, three of which have extremely short half lives (0.8,0.2, 10 s). Lithium occurs naturally as a mixture of the two stable isotopes Li (95.58%) and Li (7.42%), which may be determined using Atomic Absorption Spectroscopy, Nuclear Magnetic Resonance Spectroscopy, or Neutron Activation analysis. Under normal circumstances it is impossible to identify isotopes by using AAS, because the spectral resolution of the spectrometer is inadequate. We have previously reported the use of ISAAS in the determination of lithium pharmacokinetics. Briefly, the shift in the spectrum from Li to Li is 0.015 nm which is identical to the separation of the two lines of the spectrum. Thus, the spectrum of natural lithium is a triplet. By measuring the light absorbed from hollow cathode lamps of each lithium isotope, a series of calibration curves is constructed, and the proportion of each isotope in the sample is determined by solution of the appropriate exponential equation. By using a dual-channel atomic absorption spectrometer, the two isotopes may be determined simultaneously. - ... 

In media selective for enterobacteria a surface-active agent is the main selector, whereas in staphylococcal medium sodium and lithium chlorides are the selectors staphylococci are tolerant of salt concentrations to around 7.5%. Mannitol salt, Baird-Parker (BP) and Vogel-Johnson (VJ) media are three examples of selective staphyloccocal media. Beside salt concentration the other principles are the use of a selective carbon source, mannitol or sodium pyruvate together with a buffer plus acid-base indicator for visualizing metabolic activity and, by inference, growth. BP medium also contains egg yolk the lecithin (phospholipid) in this is hydrolysed by staphylococcal (esterase) activity so that organisms are surrounded by a cleared zone in the otherwise opaque medium. The United States Pharmacopeia (1990) includes a test for staphylococci in pharmaceutical products, whereas the British Pharmacopoeia (1993) does not. 

Any time an ABG is analyzed it is wise to concurrently inspect the serum chemistry values to calculate the anion gap. The body does not generate an anion gap to compensate for a primary disorder. As such, if the calculated anion gap exceeds 12 mEq/L (mmol/L) there is a primary metabolic acidosis regardless of the pH or the serum HC03 concentration. The anion gap may be artificially lowered by decreased serum albumin, multiple myeloma, lithium intoxication, or a profound increase in the serum potassium, calcium, or magnesium. 

Isolated seizures that are not epilepsy can be caused by stroke, central nervous system trauma, central nervous system infections, metabolic disturbances (e.g., hyponatremia and hypoglycemia), and hypoxia. If these underlying causes of seizures are not corrected, they may lead to the development of recurrent seizures I or epilepsy. Medications can also cause seizures. Some drugs that are commonly associated with seizures include tramadol, bupropion, theophylline, some antidepressants, some antipsy-chotics, amphetamines, cocaine, imipenem, lithium, excessive doses of penicillins or cephalosporins, and sympathomimetics or stimulants. 

Mechanism of Action Lithium s pharmacologic mechanism of action is not well understood and probably involves multiple effects. Possibilities include altered ion transport, increased intraneuronal catecholamine metabolism, neuroprotection or increased brain-derived neurotrophic factor, inhibition of second messenger systems, and reprogramming of gene expression.29... 

Lithium(7Li) Lithium drug metabolism lithium-containing pharmaceuticals Li... 

Lithium is rapidly absorbed it is not protein bound, not metabolized, and is excreted unchanged in the urine and other body fluids. 

Lithium(I) ions are small but strongly hydrated and could interfere with Mg(II) biochemistry. However, the favored mode of action is interference with Ca(II) metabolism via inhibition of enzymes in the inositol phosphate pathways (470-472). Inositol phosphates are responsible for mobilizing Ca(II) inside cells in response to external stimnlii. Lithium also stimulates glutamate release presumably via activation of the AT-methyl-D-asparate receptor and leads to Ca(II) entry (473). The increased influx of intracellular Ca(II) may activate phospholipase C and stimulate accumulation of inositol 1,4,5-triphosphate (473). 

Gabapentin (Neurontin). Another anticonvulsant, gabapentin, is unique among psychiatric medications in that, like lithium, it is not metabolized by the liver but... 

Pharmacology Lithium alters sodium transport in nerve and muscle cells, and effects a shift toward intraneuronal catecholamine metabolism. The specific mechanism in mania is unknown, but it affects neurotransmitters associated with affective disorders. Its antimanic effects may be the result of increases in norepinephrine reuptake and increased serotonin receptor sensitivity. Pharmacokinetics ... 

Lithium is completely absorbed after oral administration reaching peak concentrations after 1-3 hours. Lithium is not metabolized and almost completely excreted unchanged in the urine with a half-life of on average 24 hours, but increasing to 40 hours or longer in the elderly and in patients with compromised renal function. After excretion 70-80% is reabsorbed by proximal renal tubule where it competes with sodium for reabsorption. Therefore low sodium levels decrease lithium excretion with consequent risks for lithium toxicity. 

A. Approximately 5% of patients taking lithium over the long term develop hypothyroidism, and thyroid status should be followed as routine care for these patients. Mr. Smith s symptoms are classic for hypothyroidism. Impairment in glucose metabolism, hepatic function, red blood cell production, and prolactin secretion are not typical complications of lithium therapy. 

Lithium blocks the release of thyroxine (T4) and triiodothyronine (T3) mediated by thyrotropin (Kleiner et ah, 1999). This results in a decrease in circulating T4 and T3 concentrations and a feedback increase in serum thyrotropin concentration. It also inhibits thyrotropin-stimulated adenylate cyclase activity (Kleiner et ah, 1999). Lithium has varying effects on carbohydrate metabolism. Increased and decreased glucose tolerance and decreased sensitivity to insulin have been observed (Van derVelde Gordon, 1969). In animals, lithium decreases hepatic cholesterol and fatty acid synthesis. 

Manna s data (1991) of the efficacy of a nimodipine and lithium combination are of particular interest in reference to the above hypotheses related to combined effects on calcium-related mechanisms. Lithium obviously exerts complex effects on a variety of systems in brain, but its effects on phosphoinositide turnover and cyclic adenosine monophosphate and downstream effects on 1,4,5-inositol triphosphate (IP3) metabolism in calcium-related processes (as reviewed by Berridge 1989 H. L. Meltzer 1990 and... 

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