Gadallah M F, Feinstein E I, Massry S G
Department of Medicine University of Southern California School of Medicine, Los Angeles.
Miner Electrolyte Metab. 1988;14(2-3):146-9.
Lithium therapy has various neurologic cardiovascular, and renal side effects. Lithium intoxication with a serum lithium level of greater than or equal to 3.5 mEq/l is considered potentially lethal and hemodialysis therapy is recommended. We reviewed the clinical course and therapy of 55 patients with lithium toxicity seen during a 6-year period. Forty-two patients had acute lithium intoxication following the ingestion of an overdose. In 13 patients, toxicity developed during maintenance therapy with the drug. The patients with acute intoxication had significantly milder symptoms than those with chronic intoxication. Ten patients with acute intoxication had a serum lithium concentration of 3.5 mEq/l or higher. None of these 10 patients had severe neurologic or cardiovascular symptoms. Five patients were treated with hemodialysis and 5 patients were not. Serum lithium concentration did not differ between the two groups (4.7 +/- 0.7 and 5.7 +/- 1.0 mEq/l, respectively). No patient in either group died or suffered permanent sequelae of lithium toxicity. In conclusion, patients with acute lithium toxicity frequently have mild symptoms, despite potentially lethal levels and may not require hemodialysis therapy. On the other hand, patients who develop toxicity while receiving chronic maintenance therapy are more likely to have severe symptoms. Patients with severe symptoms and serum lithium levels above the therapeutic range should be treated with hemodialysis.
锂盐治疗有多种神经、心血管和肾脏方面的副作用。血清锂水平大于或等于3.5 mEq/L的锂中毒被认为有潜在致命性，建议进行血液透析治疗。我们回顾了6年间55例锂中毒患者的临床病程及治疗情况。42例患者因过量摄入导致急性锂中毒。13例患者在药物维持治疗期间出现中毒。急性中毒患者的症状明显比慢性中毒患者轻。10例急性中毒患者的血清锂浓度为3.5 mEq/L或更高。这10例患者均无严重的神经或心血管症状。5例患者接受了血液透析治疗，5例未接受。两组患者的血清锂浓度无差异（分别为4.7±0.7和5.7±1.0 mEq/L）。两组均无患者死于锂中毒或出现永久性后遗症。总之，急性锂中毒患者尽管血清锂水平可能达到致命程度，但通常症状较轻，可能不需要血液透析治疗。另一方面，在接受慢性维持治疗期间出现中毒的患者更可能有严重症状。有严重症状且血清锂水平高于治疗范围的患者应接受血液透析治疗。
