Lithium Intoxication with Impaired Renal Function

鋰鹽中毒及腎功能障礙

吳幼雯(Ana Isabel Wu) ； 張勝傑(Shen-Chieh Chang) ； 陳作孝(Tso-Hsiao Chen) ； 沈武典(Winston W. Shen)

《台灣精神醫學》 23卷4期 (2009/12) Pp. 343-352

https://doi.org/10.29478/TJP.200912.0011

摘要

背景：鋰鹽一直都治療雙極性疾患的主要用藥之一。美國食品暨藥物管理局在1970年核可其用在治療急性躁症，並於1974年通過其作為維持治療的適應症。然而，由於鋰鹽的治療濃度範圍窄，且常產生許多副作用，使精神科醫師在鋰鹽的臨床使用上常面臨困難。在個案討論會中，作者提出了一位鋰鹽中毒的個案在會議上討論。個案：一位44歲女性已服用鋰鹽16年，近來因呼吸困難、意識狀態改變、手抖及情緒低落二度進出某綜合醫院急診，而後住進該院內科病房。其異常血液檢查結果包括血液鋰鹽濃度3.31 mEq/L、血中尿素氮(BUN) 60 mg/dL、血清肌酸酐(creatine) 44 mg/dL、尿比重1.006及腎絲球過濾率19.6 mL/min。結論：在此次個案討論會中，我們討論了鋰鹽急性、慢性中毒的臨床表現及其治療策略，同時也探討了雙極性疾患除鋰鹽之外的其他用藥選擇。

關鍵字

鋰鹽中毒 ； 腎臟功能 ； 腎臟病變

並列摘要

Background: Lithium is a time-honored medication for treating bipolar disorder. The Food and Drug Administration of the United States approved the indication of lithium for treating acute mania in 1970 and for prophylaxis of bipolar disorder in 1974. But lithium is notorious for its narrow therapeutic window and numerous side effects which need to be highlighted for practicing psychiatrists occasionally. Thus, we present this clinical conference of a patient with various lithium-related side effects to familialize psychiatrist readers. The Case: This 44-yearold Taiwanese female patient with a history of bipolar I disorder and 16-year lithium treatment, was admitted to the medical ward of a general hospital after two visits at emergency department. Her clinical pictures showed difficulty in breathing, fluctuating consciousness, hand tremors, and dysphoric mood. Her abnormal laboratory findings showed serum lithium levels 3.31 mEq/L and 2.76 mEq/L on two occasions, BUN 60 mg/dL, creatinine 4.4 mg/dL, urine specific gravity 1.006, and estimated glomerular filtration rate19.6 mL/min. Conclusion: In this case conference, we have discussed the clinical picture of acute and chronic lithium intoxication as well as addressed the issues of treatment modalities and pathophysiology of lithium-related renal toxicity.

並列關鍵字

Lithium intoxication ； renal function ； nephropathy

參考文獻

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