Nesrin Buket TOMRUK, Arslan Mehtap DELİCE, ABDULLAH YILDIRIM, Nihat ALPAY

Akut lityum zehirlenmesinde tanı ve tedavi güçlükleri: Olgu sunumu

Lityumun (Li) bipolar bozukluk tedavisinde etkinliği kanıtlanmış olmakla birlikte, terapötik indeksi çok dardır. İdame Li tedavisi alan hastaların çoğunda, tedavi sürecinde bir noktada toksisite oluşur. Lityumun farmakokinetik özellikleri nedeniyle, intoksikasyon tipine göre klinik belirtiler farklılıklar gösterir. Bu nedenle de, toksisitenin tanınması güç olabilir. Bu sunumda, çok yüksek lityum düzeylerine rağmen, hafif ve silik semptomlar gösteren bir olgunun klinik tablosu ve tedavisi literatür ışığında tartışılmaktadır. 37 yaşında bipolar bozukluk hastasının son üç gün içinde gelişen uykusuzluk, bulantı ve ince tremoru vardı ve serum Li düzeyi 5,4 mmol/L bulundu. Hasta, son 10 gündür 1200 mg/gün Li kullanmaktaydı. Forse alkalen diürez ve destekleyici tedavi ile 24 saatte serum Li düzeyi normal seviyeye indi. Lityum, psikiyatride maksimum alım dozlarına yakın düzeylerde kullanılır. Bazı intoksikasyon olgularında serum düzeyleri normal olabilirken, bazen de akut doz aşımlarında serum düzeyi çok yüksek olabilir. Ancak olgu, normal hücre içi yoğunluk nedeni ile asemptomatik kalabilir. Lityum intoksikasyonunun şiddeti ile en iyi korelasyonu klinik semptomlar gösterirler. Olgumuz, lityum intoksikasyonu tedavisinde kararların, serum lityum düzeylerinden çok klinik parametrelere dayalı olması gerektiğini desteklemektedir.

Diagnostic and therapeutic challenges in acute lithium intoxication: A case report

Lithium (Li) is a highly efficient therapy in bipolar disorder, but its therapeutic index is extremely narrow. The vast majority of patients receiving maintenance Li therapy become toxic at some point during their course of treatment. Due to its pharmacokinetics, the clinical effects of Li toxicity vary according to the type of intoxication; and diagnosis may be difficult. We present a case of lithium intoxication in whom, despite very high serum Li levels, the clinical presentation was very subtle and we discuss treatment strategies in line with literature. A 37 year old female bipolar patient with a serum Li concentration of 5.4 mmol/L had insomnia, nausea and fine tremor which developed in the last three days. She had been on Li carbonate 1200 mg/day for the last 10 days. She recovered and her Li level returned to normal in 24 hours with forced alkaline diuresis and supportive measures. Lithium carbonate is applied in psychiatry in doses close to the maximum intake level. In some cases of Li intoxication, serum Li levels may be normal. Conversely, in acute overdoses because of Li’s delayed serum equilibrium concentration may be very high, but because of normal intracellular concentrations, the patient may be asymptomatic. Clinical symptoms correlate best with severity of intoxication. Our case supports the approach that decisions regarding treatment in Li toxicity should be based on clinical parameters rather than Li levels.

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