Masiran Ruziana, Abdul Aziz Mohammad Firdaus
Department of Psychiatry, University Putra Malaysia, Serdang, Selangor, Malaysia.
Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
BMJ Case Rep. 2017 Aug 28;2017:bcr-2017-220631. doi: 10.1136/bcr-2017-220631.
A patient with bipolar I disorder has been treated with lithium and haloperidol for the last 20 years and received an ACE inhibitor for his hypertension since 9 years ago. Despite regular clinic follow-ups and blood monitoring, he recently developed tremors and delirium. On hospital admission, serum level of lithium was far above toxic level. Mental state examination revealed an anxious and disorientated man with irrelevant speech. Immediate discontinuation of lithium resulted in slow reduction of serum lithium levels and gradual resolution of tremor but his delirium persisted for 2 weeks. His condition took a turn for the worse when he developed acute renal failure and arm abscess. We discussed about lithium toxicity and the vulnerability factors which have induced delirium and renal failure in this patient.
一名患有双相 I 型障碍的患者在过去 20 年里一直接受锂盐和氟哌啶醇治疗，自 9 年前起因高血压服用一种 ACE 抑制剂。尽管定期进行门诊随访和血液监测，但他最近出现了震颤和谵妄。入院时，血清锂水平远高于中毒水平。精神状态检查发现一名焦虑、定向障碍且言语不相关的男子。立即停用锂盐后，血清锂水平缓慢下降，震颤逐渐缓解，但他的谵妄持续了 2 周。当他出现急性肾衰竭和手臂脓肿时，病情恶化。我们讨论了锂中毒以及导致该患者谵妄和肾衰竭的易患因素。
