Webb A L, Solomon D A, Ryan C E
Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA.
Psychiatr Serv. 2001 Feb;52(2):229-31. doi: 10.1176/appi.ps.52.2.229.
Although psychiatrists in the United States have used lithium for nearly 30 years, toxicity still occurs frequently. The authors report an attempt to reduce the incidence of lithium toxicity in hospitalized psychiatric patients and to identify factors associated with toxicity.
Serum lithium levels were monitored by the drug use evaluation committee at a psychiatric hospital between 1990 and 1996. Each laboratory result showing a serum lithium level of 1.5 mmol/L or more was promptly investigated, and the results were reported quarterly to the hospital staff association.
The study found that in 6.8 percent of the 2,210 admissions during which lithium was administered, patients had serum levels of 1.5 mmol/L or higher. The number of excessive serum lithium levels decreased over the course of the study period. Only 27.8 percent of patients with excessive levels had signs and symptoms of toxicity. Of the excessive serum lithium levels that were investigated, 43.3 percent were detected in blood samples drawn at the time of admission. Women and elderly persons were significantly more likely to have excessive serum levels. Psychiatric diagnosis was not significantly associated with excessive serum levels.
Education by the drug use evaluation committee may have helped to reduce the number of patients who experienced excessive lithium levels while hospitalized. Vigilance should be emphasized for women and elderly persons.
尽管美国的精神科医生使用锂盐治疗已近30年，但锂盐中毒仍频繁发生。作者报告了一项旨在降低住院精神科患者锂盐中毒发生率并确定与中毒相关因素的尝试。
1990年至1996年期间，一家精神病医院的药物使用评估委员会对血清锂水平进行了监测。每一项显示血清锂水平达到或超过1.5 mmol/L的实验室结果都立即进行调查，并每季度向医院员工协会报告结果。
研究发现，在接受锂盐治疗的2210例入院患者中，6.8%的患者血清锂水平达到或高于1.5 mmol/L。在研究期间，血清锂水平过高的病例数量有所下降。血清锂水平过高的患者中，只有27.8%出现了中毒的体征和症状。在接受调查的血清锂水平过高的病例中，43.3%是在入院时采集的血样中检测到的。女性和老年人血清锂水平过高的可能性明显更高。精神科诊断与血清锂水平过高无显著关联。
药物使用评估委员会开展的教育工作可能有助于减少住院期间血清锂水平过高的患者数量。应重点关注女性和老年人。
