Eyer Florian, Pfab Rudolf, Felgenhauer Norbert, Lutz Jens, Heemann Uwe, Steimer Werner, Zondler Sabine, Fichtl Burkhard, Zilker Thomas
Department of Toxicology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
J Clin Psychopharmacol. 2006 Jun;26(3):325-30. doi: 10.1097/01.jcp.0000218405.02738.b3.
The clinical features and pharmacokinetics of 22 lithium overdoses are described. Effectiveness of different treatment regimens regarding elimination of lithium is discussed. Origin of overdose was due to deliberate poisoning or precipitated by concomitant diseases, coadministration of drugs, or combination of both. Treatment included supportive care, diuretics (15/22), hemodialysis (HD; 9/22), and mechanical ventilation (3/22). Severity of lithium intoxication was classified in 50% as I degrees, in 41% as II degrees, and in 9% as III degrees according to Hansen and Amdisen. Renal impairment on admission was diagnosed in 82% of the patients. Half-life of lithium in serum was 3.5 +/- 0.8 hours during the first HD, and 29 +/- 14 and 29 +/- 6 hours during therapy with diuretics or supportive treatment, respectively. Lithium clearance during HD was 160 +/- 15 mL/min, and renal clearance during HD or treatment with diuretics was approximately 20 and 15 +/- 9 mL/min, respectively. Renal lithium clearance was not influenced by HD therapy. There was no difference regarding half-life and clearance between the group that had an unspecific treatment or the group treated with diuretics. Hemodialysis is the therapy of choice for emergent extracorporeal lithium elimination. Renal impairment and interaction with other drugs were the main reasons for intoxication; thus, more cautious prescription or more frequent supervision of this patient group is warranted. It seems that treatment with diuretics does not have a beneficial effect in the overdose setting.
本文描述了22例锂中毒患者的临床特征及药代动力学。讨论了不同治疗方案在锂清除方面的有效性。中毒原因包括蓄意中毒或由伴发疾病、药物合用或两者共同作用引发。治疗措施包括支持治疗、利尿剂（15/22）、血液透析（HD；9/22）及机械通气（3/22）。根据汉森和阿姆迪森的标准，锂中毒严重程度50%为I度，41%为II度，9%为III度。82%的患者入院时被诊断为肾功能损害。首次血液透析期间血清锂半衰期为3.5±0.8小时，利尿剂治疗或支持治疗期间分别为29±14小时和29±6小时。血液透析期间锂清除率为160±15 mL/min，血液透析或利尿剂治疗期间肾脏清除率分别约为20 mL/min和15±9 mL/min。肾脏锂清除率不受血液透析治疗影响。非特异性治疗组和利尿剂治疗组在半衰期和清除率方面无差异。血液透析是紧急体外清除锂的首选治疗方法。肾功能损害及与其他药物的相互作用是中毒的主要原因；因此，对该患者群体应更谨慎地开具处方或更频繁地进行监测。利尿剂治疗在中毒情况下似乎并无有益效果。
