Department of Psychiatry 1, Landesnervenklinik Wagner-Jauregg, Linz, Austria.
Bipolar Disord. 2013 May;15(3):333-7. doi: 10.1111/bdi.12066. Epub 2013 Mar 25.
Serum lithium levels may be influenced by mood state. We report on a 58-year-old female patient suffering from rapid cycling bipolar disorder. Her serum lithium levels varied greatly, despite stable medication.
The patient was observed over a one-year period.
The patient received a stable medication of lithium carbonate (450 mg), valproate (1500 mg), and clozapine (200 mg). Investigating mood and serum lithium levels over one year revealed six manic and six depressive phases. The mean lithium serum level was 0.67 mmol/L in the depressive states, 0.39 mmol/L in the manic states (t = 4.11, p = 0.001 versus depression), and 0.40 mmol/L in the euthymic states (t = 3.58, p = 0.003 versus depression). Noncompliance was ruled out. The patient gained up to 8 kg during manic phases, accompanied by pretibial edema.
Changes in serum lithium concentration are probably not caused by altered lithium, but by water metabolism. During mania, body water increases, leading to dilution and therefore a reduction in serum lithium levels. As there is no proof for any other known cause of hypervolemia, we propose the hypothesis that the increase in body water is due to a variant of idiopathic edema.
血清锂水平可能受情绪状态影响。我们报告了一例 58 岁女性快速循环双相障碍患者。尽管药物稳定，但她的血清锂水平波动很大。
对患者进行了为期一年的观察。
患者接受碳酸锂（450mg）、丙戊酸钠（1500mg）和氯氮平（200mg）稳定治疗。对一年来的情绪和血清锂水平进行调查发现，有六次躁狂期和六次抑郁期。在抑郁期，患者的平均血清锂水平为 0.67mmol/L，在躁狂期为 0.39mmol/L（t=4.11，p=0.001 与抑郁期相比），在稳定期为 0.40mmol/L（t=3.58，p=0.003 与抑郁期相比）。排除了不遵医嘱的情况。在躁狂期，患者体重增加了 8 公斤，伴有胫前水肿。
血清锂浓度的变化可能不是由于锂的改变，而是由于水代谢的改变。在躁狂期，体内水分增加，导致稀释，因此血清锂水平降低。由于没有其他已知的高血容量的原因的证据，我们提出了这样的假设：体水的增加是由于特发性水肿的一种变体。
