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  • Title: [Erroneous diagnosis of lithium poisoning due to use of lithium-heparin bloodletting tubes].
    Author: Frankfort E, van den Bergh PJ, Drenth JP, Hekster YA, van der Werf T, Willems JL.
    Journal: Ned Tijdschr Geneeskd; 1993 May 15; 137(20):1017-8. PubMed ID: 8505988.
    Abstract:
    In two male patients, aged 53 and 21 years, lithium intoxication was suspected. The diagnosis was apparently confirmed by blood testing (the lithium concentrations amounted to 3.68 and 1.82 mmol/l, respectively). Retrospectively however it was found that blood sampling tubes with lithium-heparin as the anticoagulant had been used. No lithium intoxication was present in the patients. Clear instructions in writing are necessary to prevent this error.
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