Co zwiększa a co zmniejsza poziom litu w organizmie?

[Bright Angel]

Co zwiększa a co zmniejsza poziom litu w organizmie?

The following are some common circumstances that can increase lithium levels (instruct patients to inform you of any symptoms and get extra levels in these situations):

• Dehydration (eg, from vomiting or diarrhea, as may occur in acute gastroenteritis)

• Low-sodium diet

• Reduced renal filtration rate (eg, in glomerulonephritis and diabetic nephropathy; also age related)

• Febrile illness

• Medications:

• Thiazide diuretics (eg, hydrochlorothiazide) can produce increases from 25% to 400% (very unpredictable).

• Nonsteroidal anti-inflammatory drugs (NSAIDs; eg, ibuprofen, naproxen, meloxicam) and probably COX-2 inhibitors (eg, celecoxib,
  diclofenac) can increase levels 10% to 400% over the course of days to months.

• Angiotensin-converting enzyme (ACE) inhibitors (eg, lisinopril, enalapril) can induce up to a 400% increase over several weeks.

• Angiotensin II inhibitors (eg, losartan, valsartan) probably prompt similar effects to ACE inhibitors.

• Metronidazole

The following can decrease lithium levels:

• Mania may cause levels to go down 50% despite confirmed adherence.2 The mechanism is unclear, but it might be that lithium goes into the intracellular compartment during mania. If you increase dose to improve the plasma level, toxicity symptoms can appear—or they may appear after the mania remits and the lithium returns to the extracellular space.

• Pregnancy

• Caffeine may promote renal excretion of lithium.

The following have little effect on lithium levels:

• Amiloride is a potassium-sparing diuretic and sometimes does raise levels (need to monitor).

• Aspirin

• Furosemide is a loop diuretic.

• Sulindac is an NSAID that may or may not raise levels (need to monitor)

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[unreal]

Poziom litu obniża też teofilina (kakao), yerba mate, dwuwęglan sodu (Ranigast).