Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.
Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel.
Obes Surg. 2019 Feb;29(2):735-738. doi: 10.1007/s11695-018-3597-x.
Lithium is one of the major treatment options in bipolar disorder. Bariatric surgery can significantly modify the oral bioavailability of drugs, and lithium is no exception; although in most cases drug absorption seems to decrease, in the case of lithium, toxicity is the risk. In this article, we describe a 61-year-old male patient presented with lithium toxicity, including newly diagnosed severe bradycardia requiring a permanent pacemaker, after undergoing sleeve gastrectomy. We discuss the mechanisms behind this case, provide potential solutions for clinicians treating bariatric patients with lithium, and review previous reports of lithium toxicity post bariatric surgery. Awareness of changes in drug absorption, particularly lithium, following bariatric surgery, is prudent and essential for optimal patient care. Close clinical and drug levels monitoring is strongly advised.
锂是双相情感障碍的主要治疗选择之一。减重手术可显著改变药物的口服生物利用度，锂也不例外；尽管在大多数情况下，药物吸收似乎减少，但在锂的情况下，风险是毒性。在本文中，我们描述了一位 61 岁男性患者，在接受袖状胃切除术后出现锂中毒，包括新诊断的严重心动过缓需要永久性起搏器。我们讨论了这个病例背后的机制，为治疗接受锂治疗的肥胖症患者的临床医生提供了潜在的解决方案，并回顾了之前报道的肥胖症手术后锂中毒的病例。对于接受减重手术的患者，特别是锂，谨慎并充分了解药物吸收的变化对于优化患者护理至关重要。强烈建议进行密切的临床和药物水平监测。
