Walcher Judith, Schoecklmann Harald, Renders Lutz
Department of Nephrology, University of Kiel, Germany.
Kidney Blood Press Res. 2004;27(3):200-2. doi: 10.1159/000079812. Epub 2004 Jul 13.
BACKGROUND/AIMS: Single cases of lithium carbonate dosing in hemodialysis patients have been published. We investigate the dose-serum level relationship after single and multiple lithium acetate dosing in a hemodialysis patient and review the literature.
Lithium acetate was administered orally over a period of 11 months in a patient with major depressive episodes after being placed on hemodialysis three times a week. The serum trough levels of lithium before and after hemodialysis were analyzed. The data were compared with those reported in the literature, and potential drug interactions and the importance of the residual renal function are discussed.
No adverse events due to the lithium therapy were documented. Steady state levels of between 0.6 and 0.8 mmol/l of lithium acetate were achieved 17 days after initiating the therapy, using 24 mmol/l of lithium three times a week, in a patient with a residual diuresis of about 400 ml/day. In contrast, data reported in the literature implicate that only 9.6-14.4 mmol/l of lithium (450-600 mg of lithium carbonate) is sufficient to achieve adequate serum levels.
The residual renal function can be important for lithium clearance. The creatinine clearance does not reflect this point.
背景/目的：已有关于血液透析患者单次服用碳酸锂剂量的病例报道。我们研究了一名血液透析患者单次及多次服用醋酸锂后的剂量-血清水平关系，并对文献进行了综述。
一名每周进行三次血液透析的重度抑郁发作患者，在11个月的时间里口服醋酸锂。分析血液透析前后锂的血清谷浓度。将数据与文献报道的数据进行比较，并讨论潜在的药物相互作用以及残余肾功能的重要性。
未记录到锂治疗引起的不良事件。一名残余尿量约为400 ml/天的患者，在开始治疗17天后，使用每周三次24 mmol/l的锂，达到了醋酸锂0.6至0.8 mmol/l的稳态水平。相比之下，文献报道的数据表明，仅9.6 - 14.4 mmol/l的锂（450 - 600 mg碳酸锂）就足以达到足够的血清水平。
残余肾功能对锂的清除可能很重要。肌酐清除率并不能反映这一点。
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