Metabolic Side Effects of Lithium

Abstract

Lithium is an alkaline ion being used since 19th century. After its widespread use in psychiatric disorders, observed side effects caused skepticism about its therapeutic efficacy. Despite several disadvantages, lithium is one of the indispensible drugs used in affective disorders, especially in bipolar disorder. It became a necessity for physicians to recognize its side effects since lithium is still accepted as a gold standard in the treatment of bipolar disorder. Adverse effects of chronic administration of lithium on several organ systems are widely known. In this article metabolic effects of lithium on thyroid and parathyroid glands, body mass index and kidneys will be discussed along with their mechanisms, clinical findings, possible risk factors and treatment. One of the most common side effect of lithium is hypothyroidism. It has the same clinical and biochemical properties as primary hypothyroidism and observed as subclinical hypothyroidism in the first place. Hypothyroidism, even its subclinical form, may be associated with non-response or inadequate response and is indicated as a risk factor for development of rapid cycling bipolar disorder. Therefore, hypothyroidism should be screened no matter how severe it is and should be treated with thyroid hormone in the presence of clinical hypothyroidism. Weight gain due to lithium administration disturbs the compliance to treatment and negatively affects the course of the illness. Increased risk for diabetes, hypertension, ischemic heart disease and stroke because of weight gain constitute other centers of problem. Indeed, it is of importance to determine the risk factors before treatment, to follow up the weight, to re-organize nutritional habits and to schedule exercises. Another frequent problematic side effect of lithium treatment is renal dysfunction which clinically present as nephrogenic diabetes insipidus with the common symptoms of polyuria and polydipsia. Nephrogenic diabetes insipidus develops because of urinary concentration defects due to the detrimental effects of lithium on re-absorption of water and sodium at the level of collector tubules. Close screening of renal functions is very important in the prevention of renal damage during treatment with lithium. Moreover, it is also of importance to screen serum lithium levels as lithium intoxication episodes may increase the risk of renal failure. As a conclusion lithium still preserves its indispensability in affective disorders. Clinicians should have current knowledge about the side effects of lithium and take preventive measures to apply such an important treatment to the patients.

Keywords

• Lithium, Side Effects, Thyroid, Parathyroid, Weight Gain, Renal Functions

Lityumun Metabolik Yan Etkileri

Öz

Lityum 19. yüzyıldan bu yana tıpta kullanılan alkali bir iyondur. Lityumun psikiyatrik rahatsızlıklarda kullanımının yaygınlaşması ile birlikte yan etkilerin de gözlenmeye başlaması lityum kullanımı konusunda çekinceler doğurmuştur. Tüm bu çekincelere karşın lityumun bipolar bozukluk başta olmak üzere duygudurum bozukluklarında vazgeçilmez ilaçlardan birisidir. Lityumun halen özellikle bipolar bozuklukta altın standart sağaltım olarak kabul edilmesi yan etkilerinin iyi tanınması gerekliliğini de beraberinde getirmiştir. Lityumun süregen kullanımında çeşitli organ sistemleri üzerine olan etkileri iyi bilinmektedir. Bu yazıda metabolik yan etkiler olarak tiroid ve paratiroid bezleri ile vücut ağırlığı üzerine etkileri ve böbrekler üzerine olan etkilerinden söz edilirken bu yan etkilerin olası etki düzenekleri, klinik bulguları, olası risk etmenleri ve bu yan etkilere yönelik önlemler üzerinde durulacaktır. Lityumun tiroid üzerinde gözlenen en sık yan etkisi hipotiroididir. Klinik ve biyokimyasal özellikler bakımından primer hipotiroidi ile aynı özelliklere sahiptir ve en sık subklinik hipotiroidi olarak karşımıza çıkmaktadır. Hipotiroidi, subklinik de olsa sağaltıma yanıtsızlık veya yetersiz yanıtla ilişkili olabilir ve hızlı döngülük için bir risk etmeni olarak gösterilmektedir. Bu özellikleri nedeniyle hipotiroidi, şiddeti ne olursa olsun izleme alınmalı ve klinik hipotiroidi varlığında tiroid hormonu ile tedavi edilmelidir. Lityuma bağlı kilo artışı tedavi uyumunu bozmakta ve ruhsal rahatsızlığın seyrini olumsuz etkilemektedir. Kilo artışına bağlı gelişen diyabet, hipertansiyon, iskemik kalp hastalığı ve inme riskinde artış diğer sorun odaklarını oluşturmaktadır. Bu nedenlerle lityuma başlamadan önce risk etmenlerinin belirlenmesi, kilo takibi, beslenme alışkanlıklarının düzenlenmesi ve egzersiz programlarının önerilmesi önem taşımaktadır. Lityum kullanımı konusunda en çok sorun yaratan yan etkilerden birisi de böbrek işlev bozukluğudur. Lityuma bağlı gelişen böbrek işlevlerindeki bozulmanın çok önemli bir kısmı poliüri ve polidipsi ile karakterize nefrojen diyabetes insipidus şeklinde karşımıza çıkmaktadır. Nefrojen diayabetes insipidus, lityumun toplayıcı tübüller seviyesinde su ve sodyumun emilimini etkileyerek idrar konsantrasyon yeteneğini bozması sonucu gelişmektedir. Lityum kullanırken gelişebilecek böbrek hasarının önlenebilmesi için böbrek işlevlerinin yakın takibi önemlidir. Bununla birlikte lityum zehirlenmesi ataklarının böbrek hasarı riskini artırabileceğinden serum lityum düzeylerinin izlemi de büyük önem taşımaktadır. Sonuç olarak, lityum özellikle duygudurum bozukluklarında halen vazgeçilmezliğini korumaktadır. Bu kadar önemli bir tedavinin hastalardan esirgenmemesi için klinisyenlerin lityumun yan etkileri konusunda güncel bilgilere sahip olması ve gerekli önlemlerin alınması gerekmektedir.

Anahtar Kelimeler

• Lityum, Yan Etkiler, Tiroid, Paratiroid, Kilo Artışı, Böbrek İşlevleri

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