Maruta Kyoko
Division of Neurology, National Nichinan Hospital, Nichinan, Miyazaki.
No To Hattatsu. 2003 Sep;35(5):422-5.
A severaly retarded 30-year-old woman developed acute lithium intoxication. Since the age of 22, she had been treated with neuroleptics for her aggressive behavior. At 30 years of age, lithium carbonate was added to arrest self-injurious behavior, at an initial dosage of 300 mg/day and a maintenance dosage of 900 mg/day. She subsequently developed anorexia and weight loss, and was admitted to our hospital. After 7 months of lithium therapy, she suddenly had a high fever (38.3 degrees C), diabetes inspidus, severe hypernatremia, and became akinetic and mute. Under the suspicion of lithium intoxication, all medication was discontinued, and mannitol to increase renal lithium clearance. She was given gradually improved over a month, but remained hypothyroid. This case shows the importance of interaction of lithium carbonate and other drugs which may cause lithium intoxication. In patients with severe intellectual disabilities who are unable to complain their symptoms, lithium therapy requires particularly close attention to signs of early toxicity.
一名重度智力发育迟缓的30岁女性发生了急性锂中毒。自22岁起，她就因攻击行为接受抗精神病药物治疗。30岁时，加用碳酸锂以制止自伤行为，初始剂量为300毫克/天，维持剂量为900毫克/天。随后她出现厌食和体重减轻，并入住我院。锂治疗7个月后，她突然高热（38.3摄氏度）、尿崩症、严重高钠血症，变得运动不能且缄默。怀疑锂中毒后，停用所有药物，并给予甘露醇以增加肾脏锂清除率。她在一个月内逐渐好转，但仍存在甲状腺功能减退。该病例显示了碳酸锂与其他可能导致锂中毒的药物相互作用的重要性。在无法诉说自身症状的重度智力残疾患者中，锂治疗需要特别密切关注早期毒性迹象。
