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Hypercalcemia in patients with bipolar disorder treated with lithium: a cross-sectional study.

Twigt BA, Houweling BM, Vriens MR, Regeer EJ, Kupka RW, Rinkes IH, Valk GD - Int J Bipolar Disord (2013)

Bottom Line: Lithium-induced hyperparathyroidism (LIH) is a relative underrecognized complication of long-term lithium treatment.Symptoms of LIH can be similar to the underlying psychiatric illness, which may cause a significant doctor's delay in diagnosing LIH.Patient characteristics and laboratory results were collected during the period of June 2010 till June 2011.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Utrecht, Huispostnummer G04.228, P.O. Box 85500, Utrecht, 3508GA the Netherlands.

ABSTRACT

Background: Lithium-induced hyperparathyroidism (LIH) is a relative underrecognized complication of long-term lithium treatment. Hypercalcemia may be the first, but often overlooked, sign of LIH. Symptoms of LIH can be similar to the underlying psychiatric illness, which may cause a significant doctor's delay in diagnosing LIH. The aim of this study was to determine the prevalence of hypercalcemia in a cohort of psychiatric patients.

Methods: In this cross-sectional study, we collected data from 314 patients treated with lithium in an outpatient clinic for bipolar disorder. Patients with bipolar disorder from the same clinics, who had never been treated with lithium and of whom serum calcium levels were available, were included as controls (n = 15). Patient characteristics and laboratory results were collected during the period of June 2010 till June 2011.

Results: The mean serum calcium level was 2.49 (SD 0.11) mmol/l. The point prevalence of hypercalcemia (>2.60 mmol/l) was 15.6%. In a comparable group of psychiatric patients not using lithium, the mean serum calcium level was 2.37 mmol/l, and none of these patients had hypercalcemia (p = 0.001). The duration of lithium treatment was the only significant predictor for the development of hypercalcemia (p = 0.002).

Discussion: The prevalence of hypercalcemia in lithium-treated patients was significantly higher than that in non-lithium treated controls and correlated to the cumulative time lithium was used in this cross-sectional study. We recommend that serum calcium levels should be routinely tested in patients using lithium for timely detection of LIH or hypercalcemia due to other causes.

No MeSH data available.


Related in: MedlinePlus

Distribution curves of serum calcium levels in lithium users (n= 314) and non-lithium users (n= 15). The red line illustrates the upper limit of the serum calcium level of 2.60 (mmol/L). The two dotted lines are placed upon the mean serum calcium levels of both groups; the left dotted line corresponds with the non-lithium users, the right dotted line with the lithium users.
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Fig1: Distribution curves of serum calcium levels in lithium users (n= 314) and non-lithium users (n= 15). The red line illustrates the upper limit of the serum calcium level of 2.60 (mmol/L). The two dotted lines are placed upon the mean serum calcium levels of both groups; the left dotted line corresponds with the non-lithium users, the right dotted line with the lithium users.

Mentions: In the control group, the mean serum calcium level was 2.37 (SD 0.10) mmol/l, which was significantly (<0.001) lower compared to that of the lithium users (Table 1). None of these patients had a serum calcium level above 2.60 (mmol/l), as illustrated in Figure 1.Figure 1


Hypercalcemia in patients with bipolar disorder treated with lithium: a cross-sectional study.

Twigt BA, Houweling BM, Vriens MR, Regeer EJ, Kupka RW, Rinkes IH, Valk GD - Int J Bipolar Disord (2013)

Distribution curves of serum calcium levels in lithium users (n= 314) and non-lithium users (n= 15). The red line illustrates the upper limit of the serum calcium level of 2.60 (mmol/L). The two dotted lines are placed upon the mean serum calcium levels of both groups; the left dotted line corresponds with the non-lithium users, the right dotted line with the lithium users.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230442&req=5

Fig1: Distribution curves of serum calcium levels in lithium users (n= 314) and non-lithium users (n= 15). The red line illustrates the upper limit of the serum calcium level of 2.60 (mmol/L). The two dotted lines are placed upon the mean serum calcium levels of both groups; the left dotted line corresponds with the non-lithium users, the right dotted line with the lithium users.
Mentions: In the control group, the mean serum calcium level was 2.37 (SD 0.10) mmol/l, which was significantly (<0.001) lower compared to that of the lithium users (Table 1). None of these patients had a serum calcium level above 2.60 (mmol/l), as illustrated in Figure 1.Figure 1

Bottom Line: Lithium-induced hyperparathyroidism (LIH) is a relative underrecognized complication of long-term lithium treatment.Symptoms of LIH can be similar to the underlying psychiatric illness, which may cause a significant doctor's delay in diagnosing LIH.Patient characteristics and laboratory results were collected during the period of June 2010 till June 2011.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Utrecht, Huispostnummer G04.228, P.O. Box 85500, Utrecht, 3508GA the Netherlands.

ABSTRACT

Background: Lithium-induced hyperparathyroidism (LIH) is a relative underrecognized complication of long-term lithium treatment. Hypercalcemia may be the first, but often overlooked, sign of LIH. Symptoms of LIH can be similar to the underlying psychiatric illness, which may cause a significant doctor's delay in diagnosing LIH. The aim of this study was to determine the prevalence of hypercalcemia in a cohort of psychiatric patients.

Methods: In this cross-sectional study, we collected data from 314 patients treated with lithium in an outpatient clinic for bipolar disorder. Patients with bipolar disorder from the same clinics, who had never been treated with lithium and of whom serum calcium levels were available, were included as controls (n = 15). Patient characteristics and laboratory results were collected during the period of June 2010 till June 2011.

Results: The mean serum calcium level was 2.49 (SD 0.11) mmol/l. The point prevalence of hypercalcemia (>2.60 mmol/l) was 15.6%. In a comparable group of psychiatric patients not using lithium, the mean serum calcium level was 2.37 mmol/l, and none of these patients had hypercalcemia (p = 0.001). The duration of lithium treatment was the only significant predictor for the development of hypercalcemia (p = 0.002).

Discussion: The prevalence of hypercalcemia in lithium-treated patients was significantly higher than that in non-lithium treated controls and correlated to the cumulative time lithium was used in this cross-sectional study. We recommend that serum calcium levels should be routinely tested in patients using lithium for timely detection of LIH or hypercalcemia due to other causes.

No MeSH data available.


Related in: MedlinePlus