Lithium salts in the treatment of psychotic excitement. 1949.
Year: 2000
Type: article
Abstract: LITHIUM SALTS enjoyed their hey-day the latter half last century when, commencing with their introduction by Garrod, they. were vaunted as curative gout, and so doubtless a multitude other so-called gouty manifestations. This followed the demonstration that lithium urate was the most soluble the urates. It was shown that if pieces cartilage with urate deposits were immersed solutions sodium, potassium and lithium carbonate, the urate was dissolved first from that piece immersed the lithium carbonate solution. As time went on and were consumed on an ever-increasing scale for an ever-increasing range ailments, the toxic and depressant effects were more and more commonly seen. Garrod (1859) wrote lithium carbonate: given internally doses from one to four grains dissolved water, two to three times a day, it produces no direct physiological symptom ... their use does not appear to be attended with any injurious consequences. And certainly, that dosage, there should never be any toxic symptoms. But about fifty years later cases are reported of cardiac depression and even dilatation, as a result excessive and continued consumption tablets (The Practitioner, 1907). Cardiac depression and even dilatation was perhaps very vague physiology, but the note warning was clear, also the statement Squires's Companion to the British Pharmacopoeia that lithia salts upset the stomach very easily (The Practitioner, 1909). What with the hypothetical cardiac depression and the actual mental depression, nausea and giddiness, the uselessness lithium most the conditions for which it was prescribed, and the fact that there was other, more efficacious treatment the only disease which it had been shown to be some value, it is not surprising that lithium salts have fallen into desuetude. Culbreth (1927) says lithium bromide that it is the most hypnotic all bromides. The dosage stated there is the relatively enormous one 10 to 30 grains. It is not stated how often this huge dose might be repeated each day, but one presumes the traditional two to three times. Squires, too, states that in epilepsy it is the best all bromides and gives the dose more conservatively as five to 15 grains. It is worth noting that the hypnotic action lithium bromide was thought to be due to the fact that, the atomic weight lithium being so small, weight for weight, lithium bromide must contain more bromide ion than any other bromide. There is no evidence that the lithium ion was recognized as having a marked sedative action superior some respects to that the bromide. But 15 grains lithium bromide repeated three times a day would soon lead, not to bromide, but to far more dangerous lithium, intoxication, and it is little wonder that it has never found favour the treatment epilepsy. It is a pity, because properly used, lithium salts might well be an important addition to the anti-convulsant armamentarium. In the course some investigations by the writer into the toxicity urea when injected intraperitoneally into guinea-pigs, it appeared desirable to ascertain whether uric acid enhanced this toxicity. The great difficulty was the insolubility uric acid water, so the most soluble urate was chosen--the lithium salt. When an aqueous solution 8% urea, saturated with lithium urate, was injected, the toxicity was far less than was expected. It looked as if the lithium ion might have been exerting a protective effect. To determine this, more observations were made, lithium carbonate being used instead lithium urate. An 8% aqueous solution urea kills five out ten guinea-pigs when injected intraperitoneally doses 1-25 millilitres per ounce body weight. When 0.5% lithium carbonate an 8% urea solution was injected the same dosage, all ten animals survived; and this argued a strong protective function for the lithium ion against the convulsant mode death caused by toxic doses urea. …
Source: Europe PMC (PubMed Central)
Author: J F Cade
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1943910722