Hemodialysis followed by continuous hemofiltration for treatment of lithium intoxication in children

Hemodialysis is the usual recommended treatment for severe lithium intoxica tion; however, rebound of lithium levels may require repeated hemodialysis treatments. We proposed that the addition of continuous hemofiltration afte r hemodialysis would prevent rebound by providing ongoing clearance of lith ium. We report two pediatric patients with lithium intoxication treated by hemodialysis followed by continuous venovenous hemofiltration with dialysis (CVVHD). Both patients were symptomatic at presentation and had initial li thium levels more than three times the usual therapeutic range. Hemodialysi s followed by CVVHD resulted in rapid resolution of symptoms, followed by c ontinuous clearance of lithium without requiring repeated hemodialysis sess ions. Both patients had return of normal mental status during CVVHD treatme nt, and neither patient experienced complications of hemodialysis or CVVHD. Total duration of treatment with hemodialysis followed by CVVHD was 34.5 h ours for the first patient and 26 hours for the second patient. We conclude that hemodialysis followed by CVVHD is a safe and effective approach to th e management of lithium intoxication in children. (C) 2001 by the National Kidney Foundation, Inc.