Pedal Edema: A Rare Side Effect of Lithium

Abstract

Lithium, is an alkali ion that is used for acute treatment and prophylaxis of mood disordes over 50 years. The most seen side effects of lithium are tremor, diarrhea, polyuria, polidipsia, hypotiroidi, weight gain, nephrogenik diabetes insipidus and nausea. Due to narrow therapeutic index, intra and interpersonal variable pharmacokinetics; close monitoring of blood lithium concentrations is recommended. Also it is suggested that lithiumneuroleptic combination can increase neurotoxicity and side effects via dopamine receptor blockade. In this case report we aimed to discuss the clinic and mechanisms of probable lithium induced pedal edema in a bipolar affective disorder patient

Keywords

• Lithium
• side effects
• pedal edema

PEDAL ÖDEM: LİTYUMUN NADİR BİR YAN ETKİSİ

Abstract

Lityum 50 yılı aşkın bir süredir bipolar duygu durum bozukluklarının akut tedavi ve profilaksisinde kullanılan bir alkali iyondur. En sık görülen yan etkileri tremor, bulantı, iştahsızlık, diyare, poliüri, polidipsi, nefrojenik diabetes insipidus, guatr, hipotiroidi ve kilo artışıdır.
Dar terapotik indeksi ve kişinin kendisinde veya kişiler arasında değişken farmakokinetik özellikleri nedeni ile kan lityum konsantrasyonlarının yakın monitorizasyonu önerilmektedir. Ayrıca lityum-nöroleptik kombinasyonunun dopamin reseptör blokajını artırarak nörotoksisteye ya da yan etkilerde artışa sebep olduğu ileri sürülmektedir. Bu olgu sunumunda amacımız bipolar affektif bozukluk nedeniyle takip edilen muhtemel lityuma bağlı gelişen pedal ödem olgusunun kliniğini ve olası ödem oluşum mekanizmalarını tartışmaktır.

Keywords

• Lityum
• yan etki
• pedal ödem

References

1. Jefferson JM, Greist JH. Lithium. In: Sadock BJ, Sadock V (Editors): Comprehensive Textbook of Psychiatry.. Baltimore, , Lippincott William Wilkins USA, 2000: 2377-2390
2. Grandjean EM, Aubry J.M. Lithium: updated human knowledge using an evidence-based approach part III: clinical safety. CNS Drugs 2009; 23(5): 397-418.
3. Schou M. Lithium treatment at 52. J Affect Disord 2001; 67:21-32.
4. Ahmad M, Elnakady Y, Farooq M, W Adaan M. Lithium Induced Toxicity in Rats: Blood Serum Chemistry, Antioxidative Enzymes in Red Blood Cells and Histopathological Studies. Biol Pharm Bull 2011;34:272-77.
5. De Oliveira JL, Da Silva GB, De Abreu AKLS, De Albuquerque RN, Franco LFLG, AraúJo SMH, et al. Lithium nephrotoxicity. Rev Assoc Med Bras 2010;56:600-6.
6. El Balkhı S, Megarbane B, Poupon J, et al. Lithium poisoning: is determination of the red blood cell lithium concentration useful? Clin Toxicol 2009;47(1):8-13.
7. Boora K, Xu J, Hyatt J. Encephalopathy with combined lithium–risperidone administration. Acta Psychiatr Scand 2008; 117:394-396.
8. Powell AA, Armstrong MA:Peripheral edema. Am Fam Physician 1997;55:1721-1726

9. Witz L, Shapiro M, Shenkman L. Chlorpromazine-induced fluid retention masquerading as idiopathic oedema. Br Med J 1987; 294:807-808.
10. Tushar Singh and Bir Singh Chavan. Pitting Type Pedal Edema With Lithium:A Case Report. German J Psychiatry 2008; 11: 76-78.
11. Ganong WF. Excitaple Tissue Muscle in Review of Medical Psychology. 17th ed., East Norwalk,CT, Appleton and Lange,1995:75-86
12. Braunwald E. Edema in Harrison’s Principles of ‹nternal Medicine, 13th ed., New York:Mcgraw-Hill, 1994:183-187.
13. Boora K, Xu J, Hyatt J. Encephalopathy with combined lithium–risperidone administration. Acta Psychiatr Scand 2008; 117:394-396.
14. Vieweg WV, Godleski LS, Hundley PL, Yank GR. Lithium, polyuria and abnormal diurnal weight gain in psychosis. Acta Psychiatr Scand 1988; 78:510 514.