Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, rue de Sèvres, Paris, France.
Laboratoire de chimie analytique, Faculté de Pharmacie, Université Paris Descartes, 4 avenue de l'Observatoire, Paris, France.
J Anal Toxicol. 2019 Aug 23;43(7):571-578. doi: 10.1093/jat/bkz013.
A 38-year-old man was admitted in the intensive care unit (ICU) after supposed ingestion of 504 sustained-release tablets of Theralithe™ corresponding ~200 g of lithium carbonate. At the admission, ~19.5 h after ingestion, the patient was conscious with trembling limbs, intense thirst, profuse sweats and vomiting and lithium serum concentration was 14.2 mmol/L. Toxicological screenings performed in urine and serum, were negative. Patient was treated with continuous extrarenal epuration by continue veno-venous hemodiafiltration starting (CCVHDF) 24 h post-admission and was carried on until 64 h. After 11 days in ICU, the patient was dismissed to the service without sequelae, and transferred to a psychiatric unit. To follow lithium concentrations in serum, urines and dialysates, we developed a simple, rapid and reliable method by capillary zone electrophoresis (CZE). Separation was achieved in 7 min. The method was linear between 0.14 and 1.44 mmol/L for serum samples, and between 0.07 and to 1.44 mmol/L for urines and dialysates. Limits of quantification were 0.15 mmol/L and 0.07 mmol/L for serum and others fluids, respectively. Intra- and inter-day precisions expressed as CV were systematically inferior to 12.1% for serum and 8.2% for other fluids. Results obtained regarding precision, accuracy, recovery and stability were satisfying, with recoveries ranging from 91.0 to 102.0%. Serum, urine and dialysate samples were measured using CZE and flame photometry. We observed a strong correlation between both methods as assessed by linear regression and Bland-Altman analysis. For the intoxicated patient, the assay was successfully applied to serum, urine and dialysates to determine the amount of lithium present in circulation and excreted. Lithium amounts in dialysates were estimated to correspond to 89% of total lithium excreted during CCVHF session while urine excretion account only for 11%.
一位 38 岁男性被收入重症监护病房（ICU），据报摄入了 504 片 Therali th™ 控释片，相当于约 200g 碳酸锂。在入院时，即摄入后约 19.5 小时，患者意识清醒但四肢颤抖、极度口渴、大量出汗和呕吐，锂血清浓度为 14.2mmol/L。尿液和血清中的毒理学筛查均为阴性。患者入院 24 小时后开始接受连续肾脏外清除治疗，持续静脉-静脉血液透析滤过（CCVHDF），直至 64 小时。在 ICU 治疗 11 天后，患者无后遗症出院，转至精神科病房。为了监测血清、尿液和透析液中的锂浓度，我们开发了一种简单、快速和可靠的毛细管区带电泳（CZE）方法。分离在 7 分钟内完成。该方法在血清样本中在 0.14 至 1.44mmol/L 之间呈线性，在尿液和透析液中在 0.07 至 1.44mmol/L 之间呈线性。血清和其他液体的定量限分别为 0.15mmol/L 和 0.07mmol/L。血清和其他液体的日内和日间精密度（表示为 CV）均系统低于 12.1%和 8.2%。精密度、准确度、回收率和稳定性的结果令人满意，回收率范围为 91.0%至 102.0%。使用 CZE 和火焰光度法测量血清、尿液和透析液中的样本。我们通过线性回归和 Bland-Altman 分析评估两种方法之间具有很强的相关性。对于中毒患者，该方法成功应用于血清、尿液和透析液，以确定循环和排泄中存在的锂量。透析液中的锂量估计占 CCVHDF 期间总锂排泄量的 89%，而尿液排泄量仅占 11%。
