Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T21:32:17.221Z Has data issue: false hasContentIssue false

Lithium Carbonate – a Competitive Aldosterone Antagonist?

Published online by Cambridge University Press:  02 January 2018

Paul M. Stewart*
Affiliation:
University Department of Medicine, West General Hospital, Edinburgh
Sheila M. Atherden
Affiliation:
University Department of Medicine, West General Hospital, Edinburgh
Susan E. Stewart
Affiliation:
University Department of Medicine, West General Hospital, Edinburgh
Lawrence Whalley
Affiliation:
University Department of Psychiatry, Royal Edinburgh Hospital
Christopher R. W. Edwards
Affiliation:
University Department of Medicine, Western General Hospital, Edinburgh
Paul L. Padfield
Affiliation:
University Department of Medicine, Western General Hospital, Edinburgh
*
Dr P. M. Stewart, Sir Stanley Davidson Lecturer in Medicine, Department of Medicine, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU

Abstract

Plasma renin activity (PRA), aldosterone (aldo) levels, electrolyte levels, and blood pressures were measured in 16 patients with affective disorders taking lithium prophylactically, and in 16 age and sex-matched control subjects. PRA and aldo levels were significantly elevated in the lithium-treated group. There was no difference between the groups in plasma electrolytes or erect and supine blood pressures, arguing against secondary aldosteronism. In the lithium-treated group, there was a significant positive correlation between both PRA and plasma aldo vs serum lithium. We postulate that lithium inhibits the action of aldosterone on the distal tubule in the kidney. Activation of the renin angiotensin system maintains normal blood pressure and plasma electrolytes.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1988 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al-Dujaili, E. A. S. & Edwards, C. R. W. (1981) Optimisation of a direct radioimmunoassay for plasma aldosterone. Journal of Steroid Biochemistry, 14, 481487.Google Scholar
Allsopp, M. N. E., Levell, M. J., Stitch, S. R. & Hullin, R. P. (1972) Aldosterone production rates in manic–depressive psychosis. British Journal of Psychiatry, 120, 399404.Google Scholar
Baer, L., Glassman, A. H. & Kassin, S. (1973) Negative sodium balance in lithium carbonate toxicity. Archives of General Psychiatry, 29, 823827.Google Scholar
Burrows, G. D., Davies, B. & Kincaid-Smith, P. (1978) Unique tubular lesion after lithium. The Lancet, i, 1310.Google Scholar
Forrest, J. N. Jr, Cohen, A. D., Torretti, J., Himmelhock, J. M. & Epstein, F. H. (1974) On the mechanisms of lithium induced diabetes insipidus in man and the rat. Journal of Clinical Investigation, 53, 11151123.Google Scholar
Georgotas, A. & Gershon, S. (1979) Lithium in manic–depressive illness: some highlights and current controversies. In Lithium Controversies and Unresolved Issues (eds Cooper, T. B., Gershon, S. & Kline, N. S.), pp. 5784. Amsterdam: Excerpta Medica.Google Scholar
Gillman, M. A. & Lichtigeld, F. J. (1986) Synergism of spironolactone and lithium in mania. British Medical Journal, 292, 661662.Google Scholar
Gutman, Y., Tamir, N. & Benakein, F. (1973) Effect of lithium on plasma renin activity. European Journal of Pharmacology, 24, 347351.Google Scholar
Haber, E., Koerner, T., Page, L. B., Kliman, B. & Purnode, A. (1969) Application of a radioimmunoassay for angiotensin I to the physiological measurement of plasma renin activity in normal human subjects. Journal of Clinical Endocrinology and Metabolism, 33, 5262.Google Scholar
Hansen, H. E., Hestbach, J., Sorensen, J. L., Norgaard, K., Heilskov, J. & Amdisen, A. (1979) Chronic interstitial nephropathy in patients on long-term lithium treatment. Quarterly Journal of Medicine, 48, 577591.Google Scholar
Hendler, N. (1975) Lithium-responsive hyperaldosteronism in manic patients. Journal of Nervous and Mental Disease, 161, 4954.Google Scholar
Hendler, N. (1978) Spironolactone prophylaxis in manic depressive disease. Journal of Nervous and Mental Disease, 166, 517520.Google Scholar
Lazarus, J. H. (1986) Lithium and the cell. In Endocrine and Metabolic effects of Lithium (ed. Lazarus, J. H.) pp. 3134. London: Plenum Medical Book Company.Google Scholar
Murphy, D. L., Goodwin, F. K. & Bunney, W. E. Jr (1969) Aldosterone and sodium response to lithium administration in man. The Lancet, ii, 458461.Google Scholar
Padfield, P. L., Morton, J. J., Lindop, G. & Timbury, G. C. (1975) Lithium induced nephrogenic diabetes insipidus: changes in plasma vasopressin and angiotensin II. Clinical Endocrinology, 4, 493500.Google Scholar
Pedersen, E. B., Darling, S., Kierkegaard-Hansen, A. & Amdisen, A. (1977) Plasma aldosterone during lithium treatment. Neuropsychiatry, 3, 153159.Google Scholar
Rademaker, M., Lindsay, A., McLaren, J. A. & Padfield, P. L. (1987) Home monitoring of blood pressure: usefulness as a predictor of persistent hypertension. Scottish Medical Journal, 32, 1619.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria. Archives of General Psychiatry, 35, 773782.Google Scholar
Stewart, P. M., Grieve, J., Nairn, I., Padfield, P. L. & Edwards, C. R. W. (1987) Lithium inhibits the action of fludrocortisone on the kidney. Clinical Endocrinology, 27, 6368.Google Scholar
Thomsen, K., Jensen, J. & Olesen, O. (1976) Effect of prolonged lithium ingestion on the response to mineralocorticoids in rats. Journal of Pharmacological Experimental Therapy, 196, 463468.Google Scholar
Transbol, I., Christiansen, C., Baastrup, P. C., Nielsen, M. D. & Giese, J. (1978) Endocrine effects of lithium. Acta Endocrinologica, 88, 619624.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.