Lopes Andreia, Campos Ana de Carmo, Marques Simões Joana, Jordão Alda
Clinical Pharmacology and Therapeutics Laboratory, Lisbon University Faculty of Medicine, Lisbon, PRT.
Internal Medicine, North Lisbon University Hospital Centre (CHULN) - Pulido Valente Hospital, Lisbon, PRT.
Cureus. 2023 Jul 11;15(7):e41677. doi: 10.7759/cureus.41677. eCollection 2023 Jul.
Lithium salts (lithium) is a psychotropic drug widely used as a pharmacological option in managing bipolar disorder. Regular monitoring of serum levels is necessary due to the narrow therapeutic range of lithium. Typically, the diagnosis of lithium intoxication is based on the presence of elevated plasma levels. Nevertheless, poisoning can ensue from either acute ingestion or chronic use, even in patients with normal plasma levels. The utilization of lithium has been decreasing due to its potential for multiorgan toxicity. Lithium accumulation in renal distal tubular cells is a prevalent cause of acquired arginine vasopressin resistance (AVP-R), previously known as nephrogenic diabetes insipidus (DI). Some patients might also experience neurologic persistent symptoms after plasma level normalization, a condition known as the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). We present a case report of acquired AVP-R following prolonged lithium use. This case report aims to increase awareness, particularly among those who may be unfamiliar with the use of lithium and its associated adverse reactions. In addition, it seeks to highlight the dissociation between clinical manifestations and lithium plasma levels, emphasizing the need for careful evaluation in patients receiving lithium treatment.
锂盐（锂）是一种精神药物，广泛用作治疗双相情感障碍的药理学选择。由于锂的治疗范围狭窄，定期监测血清水平是必要的。通常，锂中毒的诊断基于血浆水平升高。然而，即使血浆水平正常，急性摄入或长期使用也可能导致中毒。由于锂具有多器官毒性的可能性，其使用一直在减少。锂在肾远端小管细胞中的蓄积是获得性精氨酸血管加压素抵抗（AVP-R，以前称为肾性尿崩症（DI））的常见原因。一些患者在血浆水平正常化后也可能出现神经持续性症状，这种情况称为不可逆性锂所致神经毒性综合征（SILENT）。我们报告一例长期使用锂后发生获得性AVP-R的病例。本病例报告旨在提高认识，特别是在那些可能不熟悉锂的使用及其相关不良反应的人群中。此外，它旨在强调临床表现与锂血浆水平之间的分离，强调对接受锂治疗的患者进行仔细评估的必要性。
