Peces R, Fernández E J, Regidor D, Peces C, Sánchez R, Montero A, Selgas R
Servicio de Nefrología, Hospital Universitario La Paz, Madrid.
Nefrologia. 2006;26(3):372-8.
Lithium carbonate is commonly prescribed for the treatment of bipolar (manic-depressive) disorders. However, because of its narrow therapeutic index an excessive elevation of serum lithium concentration, either during chronic maintenance therapy or after an acute overdose, can result in serious toxicity. In addition to supportive care, the established treatment of severe lithium toxicity is haemodialysis. Conventional haemodialysis can reduce serum lithium rapidly, but post-dialysis rebound elevations with recurrent toxicity have been documented in old publications. High-flux membranes should be capable of removing more lithium per hour of haemodialysis, but published values are not available. We report here three patients with acute lithium intoxication who were treated successfully with bicarbonate and high-flux haemodialysis membranes. Our patients presented with a severe degree of intoxication, based on the amount of drug ingested, the initial serum lithium level, the severity of neurologic symptoms and systemic manifestations. Two patients developed acute renal failure probably as a result of volume depletion since it was rapidly reversible by haemodialysis and infusion therapy. In addition, consecutive haemodialysis sessions and improvement of renal function allowed a rapid decrease in serum lithium levels without haemodynamic instability or rebound elevations in lithium concentration. The effectiveness of the procedure in these cases can be attributed to the use of bicarbonate dialysate and high-efficiency dialysers. This is the first report describing the effect of high-efficiency dialysers on lithium pharmacokinetic. Using this technique the elimination rate of lithium was found to be greater than previously reported with haemodialysis.
碳酸锂常用于治疗双相情感障碍（躁狂抑郁症）。然而，由于其治疗指数狭窄，在慢性维持治疗期间或急性过量服用后，血清锂浓度过度升高可导致严重毒性。除了支持性治疗外，严重锂中毒的既定治疗方法是血液透析。传统血液透析可迅速降低血清锂水平，但旧文献中已记录到透析后锂浓度会出现反弹性升高并伴有复发性毒性。高通量膜每小时应能够清除更多的锂，但目前尚无已发表的数据。我们在此报告3例急性锂中毒患者，他们通过碳酸氢盐和高通量血液透析膜成功治愈。根据摄入药物的量、初始血清锂水平、神经症状的严重程度和全身表现，我们的患者呈现出严重的中毒程度。2例患者可能由于容量耗竭而发生急性肾衰竭，因为血液透析和输液治疗可使其迅速逆转。此外，连续的血液透析治疗和肾功能的改善使血清锂水平迅速下降，且未出现血流动力学不稳定或锂浓度反弹性升高。该方法在这些病例中的有效性可归因于使用了碳酸氢盐透析液和高效透析器。这是第一份描述高效透析器对锂药代动力学影响的报告。使用该技术发现锂的清除率高于先前报道的血液透析清除率。
