血锂浓度正常时锂盐中毒的病例报告(英文)

患者是一名18岁的女性,因首次躁狂发作而入院。给予常规剂量的碳酸锂治疗,两周后她的症状缓解;随即出院,在家服药剂量为250 mg,每天两次。出院五天后,她由于食欲差和意识模糊被送入一家综合医院急诊室。由于综合医院医师无法诊断该问题,患者被转诊送入我院。虽然入院时血锂浓度为0.57 mmol/L(即,治疗量的下限),但是她已经表现出锂盐中毒的症状,包括无尿,四肢震颤、吐词不清、肌张力升高、和腱反射亢进。给予甘露醇静滴,她的急性症状很快得到缓解。此病例说明,无论血锂浓度的高低,对使用锂盐的患者必须监测锂盐中毒的临床症状;同时必须告知患者、家属、和普通医师锂盐中毒的症状和处理。     

慢性锂中毒临床分析

目的:探讨血锂浓度≥1.0mmol/L的慢性锂中毒患者血锂浓度、中毒症状与治疗之间的关系。方法:查阅150例血锂浓度≥1.0mmol/L的慢性锂中毒患者的病历记录,采集人口学资料及临床特征。结果:高剂量、高龄、女性、合并苯二氮艹卓类药物者血锂浓度较高。中毒症状与血锂浓度密切相关,血锂浓度越高,越容易中毒。血液透析对锂的排除率高于常规治疗。结论:长期服用锂盐的患者应监测血锂浓度,警惕危险因素,临床医生需密切观察中毒症状。     

碳酸锂治疗的躁狂发作患者血锂浓度与肾小球滤过率的关系

目的探讨锂盐代谢与肾小球滤过率的关系。方法收集52例接受碳酸锂治疗的躁狂发作患者,检测治疗前血肌酐、尿素氮、体表面积、血钠浓度等指标,同时根据肾脏病膳食改善(the modification of diet in renaldisease,MDRD)方程估算肾小球滤过率(estimated glomerular filtration rates,eGFR);在给予口服碳酸锂1.0 g/d 1周后测定稳态血锂浓度。对上述各项指标与血锂浓度进行相关分析。结果患者组的稳态血锂浓度为0.2～1.0 mmoL/L,平均(0.52±0.18)mmoL/L。单因素分析显示,血锂浓度与体表面积、eGFR负相关(r=-0.33,P=0.02;r=-0.30,P=0.03)。多元线性回归分析也显示血锂浓度与体表面积、eGFR间负相关(β=-0.31,P=0.02;β=-0.28,P=0.03),未发现血锂浓度与血肌酐、尿素氮相关(P>0.05)。结论本研究结果提示eGFR可以作为个体代谢锂盐能力的预测指标之一。     

红细胞锂、血浆（清）锂与临床安全性的探讨

本文报告单用锂盐治疗的31例情感、分裂情感性精神病人135例次红细胞锂和血浆锂测定结果的相关、回归分析。结果显示：红细胞锂与血浆锂呈正相关（r＝0．8174）。同时结合临床，对二者浓度水平及其比值进行了分析。发现有5例次血浆锂超过1．2mEq/L，同时相应红细胞锂超过1mEq/L，两者比值超过0．8：1，即有4例次出现了中毒症状。提示在临床上，当达到上述标准时，要警惕有出现锂中毒的可能性。     

香港首创锂盐专科诊治状况初探

调查了香港锂盐专科初成立时的诊治状况，与西方锂盐诊所进行了跨文化比较。发现中国患者有较多的单相躁狂症，而单相抑郁症则低于西方，精神分裂症改变诊断为心境障碍和分裂情感性精神病颇普遍，对锂盐专科的特点及长处进行了讨论。     

躁狂症患者体液锂浓度与剂量,疗效的关系

本文对11例躁狂症患者体液锂浓度与临床疗效及剂量的关系进行了研究,结果显示:当临床上取得显效时,血锂浓度为1.0±0.4mmol/L,唾液锂浓度为1.67±0.82mmol/L,脑脊液锂浓度为0.42±0.26mmol/L。体液锂浓度与剂量呈正相关,血锂浓度与唾液浓度之比为1∶2.3,且二者相关系数为0.537,脑脊液锂为血锂浓度的37.3—53.4%。中毒时体液浓度可能不变,故在应用碳酸锂时应密切观察临床表现和中毒症状,不能只用体液浓度衡量是否中毒。     

锂盐及联合氯丙嗪或氯氮平治疗躁狂发作的对照研究

为比较单用锂盐及合并氯丙嗪或氯氮平治疗躁狂发作的疗效及副反应情况，我们设计了本研究，现报道如下。１对象和方法１１对象入组病例为我院住院患者，符合ＣＣＭＤ—２—Ｒ躁狂发作诊断标准，无严重躯体疾患。按照入院先后随机分为三组，Ａ组以氯丙嗪合并锂盐治疗，Ｂ...     

阿立哌唑合并锂盐治疗躁狂症临床观察

目的:探讨阿立哌唑合并锂盐治疗躁狂症的临床疗效。方法:将83例躁狂症患者随机分成阿立哌唑合并锂盐组(研究组)和锂盐组(对照组)治疗6周。于治疗前和治疗后第4天和第1、2、3、6周用Bech-Rafaelsen躁狂量表(BRMS)、临床疗效总评量表(CGI-SI)和治疗中出现的症状量表(TESS)评定病情的严重程度、疗效和不良反应。结果:研究组和对照组在治疗后第4天、1周、2周、3周后BRMS评分差异有显著性(P<0.05),研究组降分较快,不良反应相仿。结论:阿立哌唑合并锂盐治疗躁狂症出现疗效较单用锂盐快。     

情感性精神病患者碳酸锂药代动力学初步观察

锂盐是治疗躁狂症公认的有效药物,兼具预防作用,晚近更有文献报导对忧郁症的发作亦有类似功效。然而锂盐的应用,在国内不甚普遍,究其原因,可能是:(1)锂盐的治疗有效血浓度和中毒血浓度甚相接近,在应用时稍有不慎,每招致毒付反应,尤其是凭经验给药而缺乏血药浓度的监测时,药量更不易掌握;(2)在临床应用时,有效剂     

影响血锂浓度的临床因素分析

锂盐已广泛应用于情感性精神病的治疗。治疗过程中需测定血锂浓度,治疗最佳量控制在0.8～1.2mmol/L。小于此量,疗效不佳,而大于此量,易发生中毒。因此,血锂浓度测定的准确性尤为重要。众所周知,血锂测定又受多种因素影     

卡马西平与碳酸锂治疗躁狂发作的对照研究

目的 评价卡马西平治疗躁狂发作的疗效和副反应。方法 对符合ＣＣＭＤ－２－Ｒ中情感性障碍躁狂发作诊断标准的１７２例病人随机分成卡马西平组（１０２例）和碳酸锂组（７０例）,治疗４周;使用躁狂量表（ＢＲＭＳ）和临床疗效总评量表（ＣＧＩ）评定疗效,用副反应量表（ＴＥＳＳ）及有关实验室检查评定副反应。结果 两组疗后４周ＢＲＭＳ总分减分率显著低于疗前（Ｐ〈０．０１）,说明卡马西平能有效治疗躁狂发作,其疗效与碳酸锂相近,但副反应较碳酸锂持续时间短,病人易耐受。结论 卡马西平可作为躁狂发作的首选药物。     

Studies on the use of blood lithium concentrations in lithium therapy in Japan

The relationship between the concentration of lithium in whole blood and plasma was determined in 11 manic-depressive patients 12 h after the evening dose of lithium carbonate taken in the form of slow release tablets (Limas). Significant relationships were found between the concentration of lithium in whole blood and plasma as well as between the daily dose of lithium and the lithium concentration in whole blood and in plasma. The findings suggest that under certain conditions the concentration of lithium in a small sample of whole blood may be used to monitor lithium therapy in outpatients. The advantages of using whole blood are discussed.     

The benefit of lithium carbonate adjunct in refractory depression--fact or fiction?

Our group attempted to validate previous claims of rapid success with lithium carbonate adjunct therapy in antidepressant-resistant depression. Seven depressed patients volunteered for a study of placebo controlled, double-blind design. During their treatment on general hospital psychiatric wards, these patients received antidepressant medication for a period of at least 21 days. While continuing to receive antidepressant medication after the 21 day period, four of the patients then received lithium carbonate, and three received placebo. This combination pharmacological therapy continued for a 48 hour period. After this time, six of the seven patients showed no significant improvement. The remaining patient, who had received lithium carbonate, improved markedly over the 48 hour period. However, this patient relapsed within one week. A review of the two most extensive studies claiming significant results with the lithium carbonate adjunct therapy was performed. We feel that they, as presented, leave serious doubt as to the validity of their conclusions. We conclude that on the basis of our work up to this point in time and the analysis of previous reports claiming otherwise, no valid evidence exists for a consistent therapeutic effect of lithium carbonate adjunct in antidepressant-resistant depression. It was also found that methodologic contamination necessitated the exclusion of an additional six patients from the double-blind trial. We conclude that in order to objectively examine the rapidly expanding field of biological psychiatry, teaching of clinical staff in basic research procedure should be stressed as a part of routine ward orientation.     

Genetic determinant of lithium ion distribution. An in vitro and in vivo monozygotic-dizygotic twin study.

In previous research, evidence was provided of genetic control of in vitro red blood cell (RBC) uptake of lithium ion following a 24-hour incubation using a monozygotic (MZ)-dizygotic (DZ) twin study method. To extend these data, in vitro RBC lithium ion concentrations were assessed for five MZ and five DZ twin pairs. To extend this line of research on genetic control of lithium ion distribution to in vivo conditions, these twin pairs were administered lithium carbonate for seven days during which time RBC and plasma lithium ion concentrations were assessed. In this limited sample, the data provide evidence of genetic control of distribution of lithium ion across the RBC membrane in vivo as well as of in vitro RBC uptake of lithium ion.     

Three cases of severe mania successfully treated with high-dosage lithium-carbonate

Three female patients suffering from severe mania, who failed to respond to increasingly high dosages of highly potent neuroleptics, were put on a high-dose regime of lithium carbonate. With rapidly increasing daily doses of lithium carbonate, blood levels of approximately 1.3-1.51 mmol/l were achieved. When high lithium levels had been attained the patients showed a considerable improvement between 75 and 82 percent on the Bech-Rafaelsen Scale. At the same time it proved possible to reduce additional medication. Not toxic effects of lithium carbonate were observed. The consequences for clinical practice (e.g. shortened duration of hospitalization) are discussed.     

碳酸锂、丙戊酸钠及奎硫平对双相障碍患者认知功能的影响

目的:探讨碳酸锂,丙戊酸钠和奎硫平对双相障碍患者认知功能的影响。方法:110例稳定期双相障碍I型患者分成4组,分别是碳酸锂组26例,丙戊酸钠组24例,碳酸锂+奎硫平组27例和丙戊酸钠+奎硫平组33例。采用数字符号,连线测验,数字广度,视觉再生,言语流畅性测验,威斯康星卡片分类测验(WCST)和汉诺塔检测认知功能,比较组间认知功能的差异。结果:Spearman相关分析显示,病程与所有认知功能指标均无显著相关(P均>0.05)。方差分析显示,汉诺塔计划时间组间差异有统计学意义(F=3.5,P<0.05)。LSD检验表明,碳酸锂组的汉诺塔计划时间成绩分别比丙戊酸钠组,碳酸锂+奎硫平组和丙戊酸钠+奎硫平组差,差异有统计学意义(P<0.05)。结论:碳酸锂可能对稳定期双相障碍患者的某些执行功能有损害。     

The effect of lithium on pupillary response to pulses of light in sheep

Administration of lithium carbonate to sheep in the dose range of 600–1800 mg/day resulted in a linearly described rise in lithium levels in plasma and red blood cells. In contrast to the rodent model but in agreement with the human condition, plasma lithium levels exceeded those of red blood cells. Polydipsia and body weight changes were not evident. At plasma levels of 0.70– 0.8 mM/1, lithium attenuated the ability of the pupil to constrict in response to 30-sec pulses of light in the 25–150 μW/cm² intensity range but not the ability to dilate in the dark. Thus, similar to observations in normal human volunteers and bipolar patients, lithium reduces sensitivity to light. The sheep is proposed as a useful model for studying the actions of lithium.     

Renal function in chronic lithium-treated patients

We investigated the renal function (urine volume, glomerular filtration rate, urinary osmolality and proteinuria) of 50 patients chronically treated with lithium carbonate for major affective disorder. No patient had any alteration in the parameters considered. No relationship was found between any of the parameters studied and duration of illness or lithium levels, both in serum and red blood cells. These results were confirmed by the administration of the DDAVP test to 10 patients of the original sample; no alteration of concentration ability was found. We suggest that the discrepancy between our findings and those of most authors was a result of the serum lithium level of our patient sample, which was lower than that usually used in other studies.