Comparison of patients hemodialyzed for lithium poisoning and those for whom dialysis was recommended by PCC but not done: what lesson can we learn?
Bibliographic record
Abstract
AIMS: To compare patients for whom hemodialysis was done for lithium poisoning and those for whom it was recommended by the poison control centre (PCC) but not done and to evaluate the effect of withholding hemodialysis on outcomes. METHODS: All lithium overdoses brought to the attention of the PCC were prospectively followed from January 1 to December 31, 1996. Patients for whom hemodialysis was done were compared with those for whom it was recommended but not done in terms of clinical presentation, lithium elimination half-life, need for transfer to another centre for hemodialysis, and outcome (death, or sequel or recovery). RESULTS: A total of 205 cases of lithium overdoses were collected including 110 with levels higher than 1.5 mmol/l. There were 12 acute lithium overdoses; no patients required hemodialysis and there were no sequel or deaths. There were 174 acute on chronic overdoses; hemodialysis was recommended in 9 patients but only 6 underwent hemodialysis; one patient died during hemodialysis but no other had sequel. There were 19 chronic poisonings; hemodialysis was recommended in 9 patients but only 2 had hemodialysis, a third patient underwent hemodialysis despite it not being recommended; one patient died without hemodialysis and one other had sequel after hemodialysis. No difference were observed between the groups for age, sex, type of poisoning (acute on chronic/chronic), levels (initial/peak/6 hours/extrapolated at 30 hours), time of presentation post-ingestion, presence of co-ingestants, symptoms and signs, Hansen and Amdisen grade, initial creatinine, time of recommendation to perform hemodialysis (daytime or nighttime), need to transfer patients to another centre to perform hemodialysis, and outcome. Patients with acute on chronic poisoning that were not hemodialyzed had longer elimination half-life than those for whom hemodialysis was done even before hemodialysis was performed: 50.1 +/- 13.6 h (n = 3) versus 12.9 +/-12.1 (n = 3) (p = 0.007), respectively. CONCLUSION: No difference was observed between patients for whom hemodialysis was done and those for whom it was recommended by PCC but not done. Despite the death of one patient clearly associated with voluntary withholding hemodialysis, sequel was not seen in that group. The indications for hemodialysis in lithium poisoning should be reconsidered to include only the more severe cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".