Abstract
The kinetics of lithium (Li +) distribution after a single dose was studied in healthy human subjects. Experiments were performed by simultaneously following changes of Li+ concentration in plasma, erythrocytes (RBC), and urine. The data were fitted by a simple but physiologically realistic model, so that extracted rate constants could be assigned to real body compartments and compared with independent measurements of cellular transport characteristics. The extracted rate constants were used to calculate steady-state cell-to-plasma Li+ ratios for RBC and for inaccessible cells (mainly muscle). In both cell types, the intracellular Li+ concentration is far below electrochemical equilibrium. This finding suggests that the Li+ countertransport efflux mechanism of RBC may be shared with muscle. We also present evidence for a circadian rhythm in Li+ excretion that parallels the daily cycle of Na+ and K+ excretion.
Similar content being viewed by others
References
P. J. Talso and R. W. Clarke. Excretion and distribution of lithium in the dog.Am. J. Physiol. 166:202–208 (1951).
J. Foulks, G. H. Mudge, and A. Gilman. Renal excretion of cation in dog during infusion of isotonic solutions of lithium chloride.Am. J. Physiol. 168:642–649 (1952).
B. E. Ehrlich and J. M. Diamond. An ultramicro method for analysis of lithium and other biologically important cations.Biochim. Biophys. Acta 543:264–268 (1978).
I. R. Poust, A. G. Mallinger, J. Mallinger, J. M. Himmelhoch, and I. Hanin. Pharmacokinetics of lithium in human plasma and erythrocytes.Psychopharmacol. Commun. 2:91–103 (1976).
P-E. E. Bergner, K. Berniker, T. B. Cooper, J. R. Gradijan, and G. M. Simpson. Lithium kinetics in man: effect of variation in dosage pattern.Br. J. Psychiat. 49:328–339 (1973).
G. Lanczos.Applied Analysis, Prentice-Hall, Englewood Cliffs, N.J., 1956.
F. Acton.Numerical Methods that Work, Harper & Row, New York, 1970.
C. Clausen, S. A. Lewis, and J. M. Diamond. Impedance analysis of a tight epithelium using a distributed resistance model.Biophys. J. 26:291–318 (1979).
T. C. Ruch and H. D. Patton.Physiology and Biophysics, W. B. Saunders, Philadelphia, 1966.
C. M. Metzler, G. L. Elfring, and A. J. McEwen. A package of computer programs for pharmacokinetics modeling.Biometrics 30:562–563 (1974).
B. E. Ehrlich and J. M. Diamond. Lithium fluxes in human erythrocytes.Am. J. Physiol. 237:C102–110 (1979).
R. W. Bonsnes and H. H. Taussky. On the colorimetric determination of creatinine by the Jaffee reaction.J. Biol. Chem. 158:581–591 (1945).
J. Brozek. Densitometric analysis of body composition: revision of some quantitative assumptions.Ann. N. Y. Acad. Sci. 110:131–140 (1963).
F. D. Moore and C. M. Boyden. Body cell mass and limits of hydration of the fat-free body: their relation to estimated skeletal weight.Ann. N. Y. Acad. Sci. 110:62–71 (1963).
R. J. Wedgwood. Inconstancy of the lean body mass.Ann. N. Y. Acad. Sci. 110:141–152 (1963).
J. G. Wagner.Fundamentals of Clinical Pharmacokinetics, Drug Intelligence Publications, Hamilton, Ill., 1975.
M. Schou. Lithium studies. 3. Distribution between serum and tissues.Acta Pharmacol. Toxicol. 15:115–124 (1958).
S. Tyrer, R. P. Hullin, N. J. Birch, and J. C. Goodwin. Absorption of lithium following administration of slow-release and conventional preparations.Psychol. Med. 6:51–58 (1976).
K. Thomsen and M. Schou. Renal lithium clearance in man.Am. J. Physiol. 215:823–827 (1968).
S. A. Lewis and J. M. Diamond. Na+ transport by rabbit urinary bladder, a tight epithelium.J. Membr. Biol. 28:1–40 (1976).
B. Sarkardi, J. K. Allimoff, R. B. Gunn, and D. C. Tosteson. Kinetics and stochiometry of Na+-dependent Li+ transport in human red blood cells.J. Gen. Physiol. 72:249–265 (1978).
W. C. Hamilton.Statistics in Physical Science, Ronald Press, New York, 1964.
M. Braun.Differential Equations and their Applications, Springer-Verlag, New York, 1970.
K. M. Brown and J. E. Dennis, Jr. Derivative-free analogues of the Levenberg-Marquardt and Gauss algorithms for nonlinear least squares approximation.Numer. Math. 8:289–297 (1972).
I. R. Poust, A. G. Mallinger, J. Mallinger, J. M. Himmelhoch, J. F. Neil, and I. Hanin. Effect of chlorothiazide on the pharmacokinetics of lithium in plasma and erythrocytes.Psychopharmacol. Commun. 2:273–284 (1976).
H. E. de Warner.The Kidney, Churchill Livingstone, London, 1973.
S. W. Stanbury and A. E. Thomson. Diurnal variations in electrolyte excretion.Clin. Sci. 10:267–293 (1951).
D. F. Smith. Diurnal variations of lithium clearance in the rat.Int. Pharmacopsychiat. 8:99–103 (1973).
W. Greil, F. Eisenried, B. F. Becker, and J. Duhm. Interindividual differences in the Na+-dependent Li+ countertransport system and in the Li+ distribution ratio across the red cell membrane among Li+-treated patients.Psychopharm. 53:19–26 (1977).
W. Nernst. Die electromotorische Wirksamkeit der Ionen.Z. Phisik. Chem. 4:129–181 (1889).
A. Amidsen and M. Schou. Biochemistry of depression.Lancet 1:507 (1967).
H. C. Caldwell, W. J. Westlake, S. M. Connor, and T. Flanagan. A pharmacokinetic analysis of lithium carbonate absorption from several formulations in man.J. Clin. Pharmacol. 11:349–356 (1971).
S. Tyrer. The choice of lithium preparation and how to give it. In F. N. Johnson and S. Johnson (eds.),Lithium in Medical Practice, University Park Press, Baltimore, 1978.
R. W. Mason, E. G. McQueen, P. J. Keary, and N. McI James. Pharmacokinetics of lithium: elimination half-time, renal clearance, and apparent volume of distribution in schizophrenia.Clin. Pharmacokin. 3:241–246 (1978).
G. Sedvall, U. Pettersson, and B. Fyro. Individual differences in serum levels of lithium in human subjects receiving fixed doses in lithium carbonate. Relation to renal lithium clearance and body weight.Pharmacol. Clin. 2:231–235 (1970).
A. C. Altamura, R. Gomeni, E. Sacchetti, and E. Smeraldi. Plasma and intracellular kinetics of lithium after oral administration of various lithium salts.Eur. J. Clin. Pharmacol. 12:59–63 (1977).
S. M. Friedman. The effect of external sodium substitution on cell potassium in vascular smooth muscle.J. Physiol. 270:195–208 (1977).
E. Richelson. Lithium ion entry through the sodium channel of cultured mouse neuroblastoma cells: a biochemical study.Science 196:1001–1002 (1977).
A. Geisler, M. Schou, and K. Thomsen. Renal lithium elimination in manic-depressive patients. Initial excretion and clearance.Pharmakopsychiatrie 10:149–155 (1971).
B. Terhaag, A. Scherber, P. Schaps, and H. Winkler. The distribution of lithium into cerebrospinal fluid, brain tissue and bile in man.Int. J. Clin. Pharmacol. 16:333–335 (1978).
E. Cotlove. Mechanism and extent of distribution of inulin and sucrose in chloride space of tissues.Am. J. Physiol. 176:396–410 (1954).
G. Nichols, Jr., N. Nichols, W. B. Weil, and W. M. Wallace. The direct measurement of the extracellular phase of tissues.J. Clin. Invest. 32:1299–1308 (1953).
N. J. Birch and R. P. Hullin. The distribution and binding of lithium following its long-term administration.Life Sci. 11:1095–1099 (1972).
B. E. Ehrlich and J. M. Diamond. Lithium, membranes, and manic-depressive illness.J. Membrane Biol. 52:187–200 (1980).
V. Groth, W. Prellwitz, and E. J. Jahnchen. Estimation of pharmacokinetic parameters of lithium from saliva and urine.Clin. Pharm. Ther. 16:490–498 (1974).
J. A. Young. Electrolyte transport by salivary epithelia.Proc. Aust. Physiol. Pharmacol. Soc. 4:101–121 (1973).
A. Frazer, J. Mendels, S. K. Secunda, C. L. Cochrane, and C. P. Bianchi. The prediction of brain lithium concentrations from plasma or erythrocyte measures.J. Psychiat. Res. 10:1–7 (1973).
M. A. Baker and G. Winokur. Cerebrospinal fluid lithium in manic illness.Br. J. Psychiat. 112:163–165 (1966).
B. E. Ehrlich, J. M. Diamond, C. Clausen, L. Gosenfeld, and S. Kaufman-Diamond. The red cell membrane as a model for studying lithium's therapeutic action. In T. B. Cooper, S. Gershon, N. S. Klein, and M. Schou (eds.),Lithium: Controversies and Unresolved Issues, Excerpta Medica, Amsterdam, 1979.
J. Rybakowski, A. Frazer, and J. Mendels. Lithium efflux from erythrocytes incubated in vitro during lithium carbonate administration.Commun. Psychopharm. 2:105–112 (1978).
H. L. Meltzer, S. Kassir, D. L. Dunner, and R. R. Fieve. Repression of a lithium pump as a consequence of lithium ingestion by manic-depressive subjects.Psychopharm. 54:113–118 (1977).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ehrlich, B.E., Clausen, C. & Diamond, J.M. Lithium pharmacokinetics: Single-dose experiments and analysis using a physiological model. Journal of Pharmacokinetics and Biopharmaceutics 8, 439–461 (1980). https://doi.org/10.1007/BF01059545
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF01059545