Minden S L, Bassuk E L, Nadler S P
Brigham and Women's Hospital, Division of Psychiatry, Boston, MA 02115.
J Gen Intern Med. 1993 Jan;8(1):33-40. doi: 10.1007/BF02600293.
This case illustrates the clinical features of lithium intoxication and the problems in treating it that may arise as a result of lithium's effects on the kidney. It also demonstrates the difficulties that can develop when a delicate physiologic balance is inadvertently disrupted by nonpharmacologic interventions such as seclusion and consequent restriction of access to food and water. Patients with lithium-induced urine-concentrating defects are especially at risk for dehydration, and care must be taken to ensure adequate fluid and salt intake. This case also shows how intense negative feelings evoked by chronically mentally ill patients can adversely affect their psychiatric and medical care. While such feelings are inevitable, their impact may be lessened by improved communication and coordination between the medical and psychiatric systems of care and by the presence of psychiatrists in the general medical hospital.
该病例阐述了锂中毒的临床特征以及因锂对肾脏的影响而在治疗过程中可能出现的问题。它还表明，当诸如隔离以及随之而来的食物和水摄入受限等非药物干预措施无意中破坏了微妙的生理平衡时，可能会引发各种困难。锂诱导的尿液浓缩功能缺陷患者尤其有脱水风险，必须注意确保充足的液体和盐分摄入。该病例还展示了慢性精神病患者引发的强烈负面情绪如何对其精神和医疗护理产生不利影响。虽然此类情绪不可避免，但通过改善医疗和精神护理系统之间沟通与协调以及在综合医院配备精神科医生，其影响可能会减轻。
