Lithium induced hypercalcemia: an expert opinion and management algorithm

Zoltan Kovacs; Peter Vestergaard; Rasmus W. Licht; Sune P. V. Straszek; Anne Sofie Hansen; Allan H. Young; Anne Duffy; Bruno Müller-Oerlinghausen; Florian Seemueller; Gabriele Sani; Janusz Rubakowski; Josef Priller; Lars Vedel Kessing; Leonardo Tondo; Martin Alda; Mirko Manchia; Paul Grof; Phillip Ritter; Tomas Hajek; Ute Lewitzka; Veerle Bergink; Michael Bauer; René Ernst Nielsen

doi:10.1186/s40345-022-00283-3

Lithium induced hypercalcemia: an expert opinion and management algorithm

Zoltan Kovacs, Peter Vestergaard, Rasmus W. Licht, Sune P. V. Straszek, Anne Sofie Hansen, Allan H. Young, Anne Duffy, Bruno Müller-Oerlinghausen, Florian Seemueller, Gabriele Sani, Janusz Rubakowski, Josef Priller, Lars Vedel Kessing, Leonardo Tondo, Martin Alda, Mirko Manchia, Paul Grof, Phillip Ritter, Tomas Hajek, Ute LewitzkaVeerle Bergink, Michael Bauer, René Ernst Nielsen^*

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Article number	34
Journal	International Journal of Bipolar Disorders
Volume	10
Issue number	1
ISSN	2194-7511
DOIs	https://doi.org/10.1186/s40345-022-00283-3
Publication status	Published - 22 Dec 2022

Bibliographical note

Keywords

Affective disorder
Bipolar disorder
Lithium
Side-effects

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10.1186/s40345-022-00283-3Licence: CC BY 4.0

Kovacs et al. (2022). Lithium induced hypercalcemia - an expert opinion and management algorithmFinal published version, 815 KBLicence: CC BY 4.0

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Kovacs, Z., Vestergaard, P., Licht, R. W., Straszek, S. P. V., Hansen, A. S., Young, A. H., Duffy, A., Müller-Oerlinghausen, B., Seemueller, F., Sani, G., Rubakowski, J., Priller, J., Vedel Kessing, L., Tondo, L., Alda, M., Manchia, M., Grof, P., Ritter, P., Hajek, T., ... Nielsen, R. E. (2022). Lithium induced hypercalcemia: an expert opinion and management algorithm. International Journal of Bipolar Disorders, 10(1), Article 34. https://doi.org/10.1186/s40345-022-00283-3

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title = "Lithium induced hypercalcemia: an expert opinion and management algorithm",

abstract = "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.",

keywords = "Affective disorder, Bipolar disorder, Lithium, Side-effects",

author = "Zoltan Kovacs and Peter Vestergaard and Licht, {Rasmus W.} and Straszek, {Sune P. V.} and Hansen, {Anne Sofie} and Young, {Allan H.} and Anne Duffy and Bruno M{\"u}ller-Oerlinghausen and Florian Seemueller and Gabriele Sani and Janusz Rubakowski and Josef Priller and {Vedel Kessing}, Lars and Leonardo Tondo and Martin Alda and Mirko Manchia and Paul Grof and Phillip Ritter and Tomas Hajek and Ute Lewitzka and Veerle Bergink and Michael Bauer and Nielsen, {Ren{\'e} Ernst}",

note = "{\textcopyright} 2022. The Author(s).",

year = "2022",

month = dec,

day = "22",

doi = "10.1186/s40345-022-00283-3",

language = "English",

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journal = "International Journal of Bipolar Disorders",

issn = "2194-7511",

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Kovacs, Z , Vestergaard, P , Licht, RW, Straszek, SPV, Hansen, AS, Young, AH, Duffy, A, Müller-Oerlinghausen, B, Seemueller, F, Sani, G, Rubakowski, J, Priller, J, Vedel Kessing, L, Tondo, L, Alda, M, Manchia, M, Grof, P, Ritter, P, Hajek, T, Lewitzka, U, Bergink, V, Bauer, M & Nielsen, RE 2022, 'Lithium induced hypercalcemia: an expert opinion and management algorithm', International Journal of Bipolar Disorders, vol. 10, no. 1, 34. https://doi.org/10.1186/s40345-022-00283-3

TY - JOUR

T1 - Lithium induced hypercalcemia

T2 - an expert opinion and management algorithm

AU - Kovacs, Zoltan

AU - Vestergaard, Peter

AU - Licht, Rasmus W.

AU - Straszek, Sune P. V.

AU - Hansen, Anne Sofie

AU - Young, Allan H.

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

PY - 2022/12/22

Y1 - 2022/12/22

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

SN - 2194-7511

VL - 10

JO - International Journal of Bipolar Disorders

JF - International Journal of Bipolar Disorders

IS - 1

M1 - 34

ER -

Lithium induced hypercalcemia: an expert opinion and management algorithm

Abstract

Bibliographical note

Keywords

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