Lithium in breast milk transiently affects the renal electrolytic balance of infants

Irfan Ahmed; Muhammad Shehzad Khan; Victor Ma; Hina Magsi; Renardi Gunawan; Abdul-Mojeed Olabisi Ilyas; Najeeb Ur Rehman Lashari; Naveed Wassan; Santosh Paidi; Zulfiqar Ali; Alan W L Law; Yanpeng Zhang; William C Cho; Martin Alda; Veerle Bergink; Ishan Barman; Condon Lau

doi:10.1111/bdi.13275

Lithium in breast milk transiently affects the renal electrolytic balance of infants

Bipolar Disord. 2023 Feb;25(1):56-65. doi: 10.1111/bdi.13275. Epub 2022 Nov 28.

Authors

Irfan Ahmed^{1

2}, Muhammad Shehzad Khan¹, Victor Ma³, Hina Magsi², Renardi Gunawan⁴, Abdul-Mojeed Olabisi Ilyas^{1

5

6}, Najeeb Ur Rehman Lashari^{7

8}, Naveed Wassan⁹, Santosh Paidi^{10

11}, Zulfiqar Ali¹², Alan W L Law¹, Yanpeng Zhang¹³, William C Cho³, Martin Alda^{14

15}, Veerle Bergink^{16

17}, Ishan Barman^{10

18

19}, Condon Lau¹

Affiliations

¹ Department of Physics, City University of Hong Kong, Hong Kong SAR, China.
² Department of Electrical Engineering, Sukkur IBA University, Sukkur, Pakistan.
³ Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China.
⁴ Department of Biomedical Sciences, and Tung Biomedical Sciences Centre, City University of Hong Kong, Hong Kong SAR, China.
⁵ Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong SAR, China.
⁶ Department of Physics, Federal University Oye-Ekiti, Ekiti State, Nigeria.
⁷ Institute for Advanced Study, Shenzhen University, Shenzhen, China.
⁸ Department of Chemistry Physics and Atmospheric Sciences, Jackson State University, Jackson, Mississippi, USA.
⁹ Department of Business Administration, Sukkur IBA University, Sukkur, Pakistan.
¹⁰ Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Massachusetts, USA.
¹¹ School of Optometry, University of California, Berkeley, California, USA.
¹² Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China.
¹³ Key Laboratory for Physical Electronics and Devices of the Ministry of Education & Shaanxi Key Lab of Information Photonic Technique, Xi'an Jiaotong University, Xi'an, China.
¹⁴ Department of Psychiatry, Dalhousie University, Halifax, Canada.
¹⁵ National Institute of Mental Health, Klecany, Czech Republic.
¹⁶ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
¹⁷ Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.
¹⁸ Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Massachusetts, USA.
¹⁹ Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Massachusetts, USA.

PMID: 36409044
DOI: 10.1111/bdi.13275

Abstract

Background: The use of lithium during breast-feeding has not been comprehensively investigated in humans due to concerns about lithium toxicity.

Procedure: We analyzed lithium in the kidneys of nursed pups of lithium medicated mothers, using analytical spectroscopy in a novel rat model. The mothers were healthy rats administered lithium via gavage (1000 mg/day Li₂ CO₃ per 50 kg body weight).

Results: Lithium was detected in the breast milk, and in the blood of pups (0.08 mM), of lithium-exposed dams at post-natal day 18 (P18), during breast-feeding. No lithium was detected after breast-feeding, at P25 (4 days after cessation of nursing). The lithium pups blood had elevated urea nitrogen at P18 and reduced total T₄ at P18 and P25, indicating a longer-term effect on the kidneys and the thyroid gland. Multivariate machine-learning analysis of spectroscopy data collected from the excised kidneys of pups showed elevated potassium in lithium-exposed animals both during- and after breast-feeding. The elevated renal potassium was associated with low nephrin expression in the kidneys measured immunohistochemically during breast-feeding. After lithium exposure is stopped, the filtration of lithium from the kidneys reverses these effects. Our study showed that breastfeeding during lithium use has an effect on the kidneys of the offspring in rats.

Keywords: analytical chemistry; bipolar disorder; endocrinology; lithium; pediatrics; psychiatry; renal electrolytic imbalance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Bipolar Disorder* / drug therapy
Breast Feeding
Female
Humans
Infant
Kidney
Lithium / therapeutic use
Milk, Human* / chemistry
Potassium / analysis
Potassium / therapeutic use
Rats

Substances

Lithium
Potassium

Abstract

Publication types

MeSH terms

Substances

Grants and funding