School of Medicine, National University of Ireland, Galway, Ireland.
Department of Psychiatry, University Hospital Galway, Galway, Ireland.
Ir J Med Sci. 2019 Aug;188(3):1103-1109. doi: 10.1007/s11845-018-01963-9. Epub 2019 Jan 10.
Lithium is a medication indicated for the treatment of bipolar disorder and treatment-resistant depression, with a narrow therapeutic index. Overdose, either acute or chronic can result in neurological symptoms, requiring dialysis and admission to intensive care in some cases. Lithium toxicity is avoidable with careful monitoring. However, we have noted several recent cases of lithium toxicity in our local service and thus sought to investigate this issue in a more systematic manner.
We aimed to quantify the incidence of lithium toxicity in our local population over a single year and identify the patients most at risk. We also aimed to generate clinical recommendations on the prevention of lithium toxicity to improve patient safety.
We identified the incidence of lithium toxicity in our local population, by searching the hospital pathology database for patients with serum lithium levels greater than 1.0 mmol/L. We examined the available clinical notes for these patients.
We identified 74 serum lithium readings above 1.0 mmol/L measured in 44 individual patients. The highest recorded level was 3.2 mmol/L. Of these, 11 patients were aged 65 years or older. Hospital admission was required in 14 cases. There were missing data of note: 29.5% had no renal function/eGFR measurement at time of toxicity and 52.3% without a baseline eGFR.
Lithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over.
锂是一种用于治疗双相情感障碍和治疗抵抗性抑郁症的药物，治疗指数较窄。急性或慢性过量都可能导致神经症状，在某些情况下需要透析和入住重症监护病房。通过仔细监测可以避免锂中毒。然而，我们最近在当地服务中注意到几例锂中毒病例，因此我们希望更系统地调查这个问题。
我们旨在确定一年内当地人群中锂中毒的发生率，并确定最易受影响的患者。我们还旨在制定关于预防锂中毒的临床建议，以提高患者安全性。
我们通过搜索医院病理数据库中血清锂水平大于 1.0mmol/L 的患者，确定了当地人群中锂中毒的发生率。我们检查了这些患者的现有临床记录。
我们确定了 44 名患者中有 74 次血清锂读数大于 1.0mmol/L。记录的最高水平为 3.2mmol/L。其中 11 名患者年龄在 65 岁或以上。14 例需要住院治疗。值得注意的是，数据缺失较多：29.5%的患者在中毒时没有肾功能/eGFR 测量，52.3%的患者没有基线 eGFR。
锂中毒在我们的人群中很常见。鉴于治疗指数较窄，这表明需要仔细监测和处方，尤其是 65 岁及以上的患者。
