CASE REPORT article
Front. Toxicol.
Sec. Clinical Toxicology
Medium cut-off membrane expanded hemodialysis for Lithium removal: A Case ReportA case rSuppeport
Provisionally accepted
KATIA MATILDE PEREZ DEL VALLE1*
MARIA Moran Magro1Daniel Gaitán Tocora1Nerea Begoña Boldoba1Carmen Benito Puncel2Alberto Silva Obregón2José R Rodríguez Palomares1Gabriel de Arriba de la Fuente1- 1Department of Nephrology, Hospital Universitario de Guadalajara, Guadalajara, Spain
- 2Department of Intensive Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background:Lithium remains a first-line treatment for bipolar disorder, though its narrow therapeutic window poses a significant risk of toxicity. Severe intoxication can lead to neurologic, renal, gastrointestinal, and endocrine complications. Extracorporeal therapies are the mainstay in managing life-threatening cases, particularly when serum levelsconcentration exceed 4.0 mmol/L mmol/L or when renal function is impaired. Intermittent hemodialysis (HD) is the recommended extracorporeal treatment due to lithium's low molecular weight and minimal protein binding. Expanded hemodialysis (HDx) with medium cut-off (MCO) membranes, designed to enhance solute clearance, may represent a promising alternative. Case Report:We present a case of acute lithium intoxication in a 48-year-old male with a history of recurrent suicidal behavior and chronic lithium therapy. The patient arrived at the emergency department in a deep coma (GCS 3), with a serum lithium concentration of 4.5 mmol/Lmmol/L and preserved renal function. He underwent two intermittent HDx sessions using a Theranova® TH-400 MCO membrane. Serum lithium levels concentration declined to 1.6 mmol/L mmol/L after the first session and progressively to 0.1 mmol/Lmmol/L within 72 hours. No treatment-related complications were observed. Conclusion:This case described the potential utility of HDx with the MCO membrane (Theranova® 400) in managing severe lithium poisoning, achieving effective and sustained drug clearance. While HDx-MCO may offer a viable alternative to conventional HD, especially in settings where enhanced solute removal is desirable, further studies are needed to determine its efficacy and clinical role in lithium toxicity management.
Keywords: Lithium, Expanded hemodialysis, HDX, Medium cut-off membrane, Toxicity, Extracorporeal blood purification
Received: 31 Jul 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 PEREZ DEL VALLE, Moran Magro, Gaitán Tocora, Boldoba, Benito Puncel, Silva Obregón, Rodríguez Palomares and de Arriba de la Fuente. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: KATIA MATILDE PEREZ DEL VALLE, nefrologiakatia@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.