Ramchandani D, Schindler B A
Medical College of Pennsylvania, Philadelphia.
Int J Psychiatry Med. 1993;23(1):55-62. doi: 10.2190/JD8Y-XVUK-A5KJ-5B62.
Patients with lithium toxicity can pose difficulties in diagnosis and management in the general hospital setting. The authors examined patients who were referred to the Psychiatric Consultation-Liaison Service with suspicion of lithium overdose to delineate and characterize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity.
The authors reviewed the charts of patients with lithium levels > 1.5 mEq/L who were admitted consecutively to a general hospital over an 18-month period.
Of twelve patients, eight were found to have developed lithium toxicity due to incidental and iatrogenic factors. These patients presented with a variety of confusing signs and symptoms. Hypothyroidism and coexisting organic illness contributed to the lack of clarity in their clinical picture.
The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which challenge the diagnostic skills of the consulting psychiatrist in a general hospital setting.
锂中毒患者在综合医院环境中的诊断和管理可能存在困难。作者对因怀疑锂过量而被转介至精神科会诊联络服务的患者进行了检查，以确定并描述中毒的医学和精神风险因素，并跟踪其毒性的病程和缓解情况。
作者回顾了在18个月期间连续入住综合医院且锂水平>1.5 mEq/L的患者病历。
在12名患者中，8名被发现因偶然和医源性因素发生了锂中毒。这些患者表现出各种令人困惑的体征和症状。甲状腺功能减退和并存的器质性疾病导致其临床表现不明确。
锂治疗适应证范围的扩大导致中毒反应风险增加，这对综合医院环境中会诊精神科医生的诊断技能构成了挑战。
