Amdisen A
Psychopharmacology Research Institute, Psychiatry Hospital in Aarhus, Risskov.
Med Toxicol Adverse Drug Exp. 1988 Jan-Dec;3(1):18-32. doi: 10.1007/BF03259929.
Lithium salts, in particular the carbonate and citrate, were formerly in widespread use, forming part of alkaline salt mixtures which were used for treatment of the many disorders belonging to the uric acid diathesis. Among these disorders were mania, depression, acute mania, acute melancholia and periodic depression. Satisfactory prophylactic effects on periodic depression were directly claimed. Daily doses of 3 to 26 mmol of lithium were recommended as standards. Only slight or moderate symptoms of poisoning were reported in a very few cases during the period in question (1860 to 1930), when the popularity of these lithium-containing prophylactic drugs with a favourable therapeutic index was at its peak. Lithium intoxication was not a serious clinical problem until 1949 when Cade introduced his fortuitously effective, but nevertheless high, dosage regimen which was continued until signs of recovery from mania appeared. For the maintenance dose, Cade in principle recommended, but seldom adhered to, 17 mmol/day. Chronic lithium intoxication starts insidiously with silent affliction of the kidneys followed by 'prodromal' symptoms, and when moderate severity has been reached, an accelerating renal vicious circle with decreasing kidney function is imminent. After this point the chronic intoxication resembles acute intoxication. Active detoxification at this, or an earlier stage, leaves the patient with a good chance of recovery. At a later stage, with the occurrence of oliguria, semi-coma or coma, and latent convulsive movement, recovery is less certain. There is no specific antidote for the toxic effects of lithium. Haemodialysis is the most effective treatment for acute lithium poisoning. For patients with impaired, or potentially impaired renal function, peritoneal dialysis may be an alternative, but less effective, treatment. Forced diuresis demands unimpaired renal function, and is little more effective than withdrawal of treatment, supplemented with correction of water and electrolyte balance. Sodium overloading is not recommended. Patients on lithium prophylaxis are treated on an outpatient basis. Prevention of intoxication depends on cooperation between patient and clinician, and possibly on the use of smaller, low risk dosages in most patients.
锂盐，特别是碳酸锂和柠檬酸锂，以前曾被广泛使用，是碱性盐混合物的一部分，这些混合物用于治疗许多属于尿酸素质的疾病。这些疾病包括躁狂症、抑郁症、急性躁狂症、急性忧郁症和周期性抑郁症。有人直接宣称对周期性抑郁症有令人满意的预防效果。推荐每日3至26毫摩尔的锂剂量作为标准。在所述时期（1860年至1930年），这些治疗指数良好的含锂预防药物的受欢迎程度达到顶峰，仅有极少数病例报告了轻微或中度中毒症状。直到1949年凯德引入了他偶然有效的但剂量仍然很高的给药方案，该方案一直持续到躁狂症恢复迹象出现，锂中毒才成为一个严重的临床问题。对于维持剂量，凯德原则上推荐，但很少坚持，为每天17毫摩尔。慢性锂中毒起病隐匿，先是悄无声息地损害肾脏，随后出现“前驱”症状，当达到中度严重程度时，肾功能下降的肾脏恶性循环即将加速。在此之后，慢性中毒类似于急性中毒。在此阶段或更早阶段进行积极的解毒治疗，患者有很大的康复机会。在后期，出现少尿、半昏迷或昏迷以及潜在的抽搐运动时，康复的确定性就降低了。对于锂的毒性作用没有特效解毒剂。血液透析是治疗急性锂中毒最有效的方法。对于肾功能受损或可能受损的患者，腹膜透析可能是一种替代方法，但效果较差。强制利尿需要肾功能正常，其效果并不比停止治疗并补充水和电解质平衡更好。不建议钠超载。接受锂预防治疗的患者在门诊接受治疗。中毒的预防取决于患者和临床医生之间的合作，可能还取决于大多数患者使用较小的低风险剂量。
