Lin Yi-Hsin, Liu Sheng-Wen, Wu Hsein-Lin, Kang Jung-Cheng, Huang Kuo-Yang, Huang Hsuan
Division of Endocrinology and Metabolism, Department of Internal Medicine.
Department of Internal Medicine.
Medicine (Baltimore). 2020 Jul 10;99(28):e21122. doi: 10.1097/MD.0000000000021122.
Lithium is the first-line medication for bipolar disorder, given a narrow therapeutic window of 0.8 to 1.2 mEq/L. Change of lithium pharmacokinetics following bariatric surgery may lead to lithium toxicity, which is particularly concerned.
We presented a 39-year-old man with morbid obesity and bipolar affective disorder for 20 years, who was treated with lithium. He developed serious lithium toxicity following sleeve gastrectomy and prolonged neurologic sequelae.
He suffered from persistent watery diarrhea, general weakness, and then drowsy consciousness. Lithium level was checked immediately to be 3.42 mEq/L and lithium toxicity was diagnosed.
After 3 courses of hemodialysis, his serum lithium level subsequently declined to 0.63 mEq/L, while his consciousness returned normal. Lithium was replaced by lamotrigine.
The patient was discharged thirty-five days after admission, while his serum lithium declined to 0.06 mEq/L. Neurologic sequelae were noted by muscle weakness and pain sensation in both feet. The nerve conduction test revealed sensorimotor polyneuropathy with conduction block. He was advised to keep a passive range of motion exercise.
Although the consensus guideline remains lacking, our report reviewed cases of relevance in the literature and highlighted the awareness of the potential risk of lithium toxicity following bariatric surgery. We suggest close monitoring of the lithium levels and perhaps a dosage adjustment for the postoperative period.
锂盐是双相情感障碍的一线用药，其治疗窗狭窄，为0.8至1.2毫当量/升。减肥手术后锂盐药代动力学的改变可能导致锂中毒，这一点尤为令人关注。
我们报告了一名39岁男性，患有病态肥胖症且双相情感障碍20年，一直在接受锂盐治疗。他在接受袖状胃切除术后出现严重的锂中毒，并伴有长期的神经后遗症。
他出现持续性水样腹泻、全身无力，随后意识模糊。立即检查锂水平为3.42毫当量/升，诊断为锂中毒。
经过3个疗程的血液透析后，他的血清锂水平随后降至0.63毫当量/升，意识恢复正常。锂盐被拉莫三嗪替代。
患者入院35天后出院，血清锂水平降至0.06毫当量/升。神经后遗症表现为双脚肌肉无力和疼痛感觉。神经传导测试显示感觉运动性多发性神经病伴传导阻滞。建议他进行被动关节活动度锻炼。
尽管目前仍缺乏共识性指南，但我们的报告回顾了文献中的相关病例，并强调了对减肥手术后锂中毒潜在风险的认识。我们建议密切监测锂水平，并可能在术后调整剂量。
