Is Capillary Electrophoresis a New Tool to Monitor Acute Lithium Poisoning in Human?

Tsandni Jamal (1) , Carole Hennequin (1) , Rabah Gahoual (2, 3) , Annie Leyris (3) , Jean-Louis Beaudeux (1) , Frédéric J Baud (4) , Pascal Houzé (1, 2, 3)

1 Service de biochimie [CHU Necker]
2 UTCBS - UM 4 (UMR 8258 / U1022) - Unité de Technologies Chimiques et Biologiques pour la Santé
3 UPD5 Pharmacie - Faculté de Pharmacie de Paris - Université Paris Descartes
4 EA_7323 - Evaluation thérapeutique et pharmacologie périnatale et pédiatrique

A 38-year-old man was admitted in the intensive care unit (ICU) after supposed ingestion of 504 sustained-release tablets of Theralithe (TM) corresponding similar to 200 g of lithium carbonate. At the admission, similar to 19.5 h after ingestion, the patient was conscious with trembling limbs, intense thirst, profuse sweats and vomiting and lithium serum concentration was 14.2 mmol/L. Toxicological screenings performed in urine and serum, were negative. Patient was treated with continuous extrarenal epuration by continue veno-venous hemodiafiltration starting (CCVHDF) 24 h post-admission and was carried on until 64 h. After 11 days in ICU, the patient was dismissed to the service without sequelae, and transferred to a psychiatric unit. To follow lithium concentrations in serum, urines and dialysates, we developed a simple, rapid and reliable method by capillary zone electrophoresis (CZE). Separation was achieved in 7 min. The method was linear between 0.14 and 1.44 mmol/L for serum samples, and between 0.07 and to 1.44 mmol/L for urines and dialysates. Limits of quantification were 0.15 mmol/L and 0.07 mmol/L for serum and others fluids, respectively. Intra- and inter-day precisions expressed as CV were systematically inferior to 12.1% for serum and 8.2% for other fluids. Results obtained regarding precision, accuracy, recovery and stability were satisfying, with recoveries ranging from 91.0 to 102.0%. Serum, urine and dialysate samples were measured using CZE and flame photometry. We observed a strong correlation between both methods as assessed by linear regression and Bland-Altman analysis. For the intoxicated patient, the assay was successfully applied to serum, urine and dialysates to determine the amount of lithium present in circulation and excreted. Lithium amounts in dialysates were estimated to correspond to 89% of total lithium excreted during CCVHF session while urine excretion account only for 11%.

Mots clés: HUMAN SERUM; ION ANALYSIS; THERAPY; CHROMATOGRAPHY; PREVENTION; MANAGEMENT; ASSAY

Domaines: Sciences du Vivant [q-bio]; Ingénierie biomédicale; Sciences de l'ingénieur [physics]

Tsandni Jamal, Carole Hennequin, Rabah Gahoual, Annie Leyris, Jean-Louis Beaudeux, et al.. Is Capillary Electrophoresis a New Tool to Monitor Acute Lithium Poisoning in Human?. Journal of Analytical Toxicology, 2019, 43 (7), pp.571-578. ⟨10.1093/jat/bkz013⟩. ⟨hal-03175919⟩