Fenves A Z, Emmett M, White M G
South Med J. 1984 Nov;77(11):1472-4. doi: 10.1097/00007611-198411000-00030.
Lithium can produce transient natriuresis, nephrogenic diabetes insipidus, and partial distal renal tubular acidosis. Lithium intoxication is commonly associated with mild renal insufficiency and may produce acute renal failure. We have described a case of acute renal failure in a patient with severe lithium intoxication, as well as cardiac arrhythmias and hypothyroidism, both of which have been reported to occur with lithium toxicity. Treatment with daily hemodialysis eventually produced complete recovery. Lithium clearance occurs quickly with hemodialysis, but a rebound effect occurs as lithium in intracellular water equilibrates with extracellular fluid. Prolonged dialysis may be required to reduce the blood lithium level to the therapeutic range. We conclude that lithium intoxication may produce severe reversible renal failure as a result of direct tubular epithelial damage.
锂可导致短暂性钠利尿、肾性尿崩症和部分远端肾小管酸中毒。锂中毒通常与轻度肾功能不全相关，且可能导致急性肾衰竭。我们描述了一例严重锂中毒患者发生急性肾衰竭的病例，该患者还伴有心律失常和甲状腺功能减退，这两种情况均有报道与锂中毒有关。每日进行血液透析治疗最终使患者完全康复。血液透析能快速清除锂，但由于细胞内水中的锂与细胞外液达到平衡，会出现反跳效应。可能需要延长透析时间才能将血锂水平降至治疗范围。我们得出结论，锂中毒可能因肾小管上皮直接损伤而导致严重的可逆性肾衰竭。
