A Case of Lithium Intoxication With Severe Neurological Findings

Öz

Lithium is used for the treatment of bipolar disorder and some other psychiatric disorders. Due to the narrow therapeutic range, intoxications are common. In this case, chronic lithium intoxication with severe neurological symptoms was discussed in light of the literature. A 72-year-old female patient. The patient had been receiving psychiatric treatment for 7 years with the diagnosis of unipolar depression. In the 6th month of lithium use, she was brought by her relatives with complaints of drowsiness, tremor, muscle twitching, and difficulty walking. On examination, consciousness was confused, there was no cooperation orientation and there was general rigidity, tremor, fasciculations, and ataxic gait. Vital signs; blood pressure 147/92 mmHg, heart rate 69 bpm, SpO2: 94%. The laboratory tests: lithium 2.98 mEq/L, potassium 5.8 mmol/l, sodium 129 mmol/l, creatinine 1.66 mg/dl, urea 166 mg/dl. The patient was transferred to the internal medicine clinic with the diagnosis of lithium intoxication. Lithium treatment was discontinued. On the 7th day, her neurological symptoms improved with supportive treatment, and biochemical parameters returned to normal. A lithium concentration of more than 3.5 mEq/L was defined as severe poisoning. Neurological findings are prominent in severe poisonings. Especially, geriatric population is at greater risk. In our case; age, use of three different groups of diuretics as antihypertensive treatment, and urinary tract infection were defined as factors that predispose to poisoning. In this case, it's emphasized that although the lithium blood level isn't very high, severe neurological symptoms can be seen clinically in the presence of risk factors.

Anahtar Kelimeler

• Lithium
• lithium intoxication
• Bipolar disorders
• Geriatrics

Ciddi Nörolojik Bulgularla Birlikte Giden Lityum Zehirlenmesi Olgusu

Öz

Lityum, bipolar bozukluğun ve diğer bazı psikiyatrik bozuklukların tedavisinde kullanılır. Dar terapötik aralık nedeniyle, zehirlenmeler yaygındır. Bu olguda ciddi nörolojik semptomlarla seyreden kronik lityum zehirlenmesi literatür ışığında tartışılmıştır. 72 yaşında, evli, eşiyle beraber yaşayan kadın hasta. Hasta unipolar depresyon tanısıyla 7 yıldır psikiyatrik tedavi alıyordu. Lityum kullanımının 6. ayında, halsizlik, uyku hali, vücutta yaygın titremeler, kas seyirmeleri, yürüme güçlüğü nedeniyle ile yakınları tarafından polikliniğe getirildi. Muayenesinde bilinç konfüzeydi, koopere değildi, oryantasyon bozlmuştu, yaygın rijidite, tremor, fasikülasyonlar ve ataksik yürüyüş mevcuttu. Vital bulgularında tansiyon 147/92 mmHg, nabız 69 atım/dakika, SpO2: %94 idi. Kan gazı normaldi. EKG normal sinüs ritminde idi. Kan tetkiklerinde; lityum 2.98 mmol/l, potasyum 5.8 mmol/l, sodyum 129 mmol/l , kreatinin 1.66 mg/dl, üre 166 mg/dl Hasta lityum zehirlenmesi ön tanısı ile dahiliye kliniğine sevk edildi. Lityum tedavisi kesildi. 7. gününde destek tedavisi ile nörolojik semptomları düzelen hastanın biyokimyasal parametreleri normale döndü. Lityum konsantrasyonunun 3.5 mEq/L'den fazla olması şiddetli zehirlenme olarak kabul edilir. Klinikte gastrointestinal, kardiyovasküler, endokrin, nörolojik, renal bulgular görülebilir. Şiddetli zehirlenmelerde nörolojik bulgular ön plana çıkar. Özellikle geriatrik popülasyon daha büyük risk altındadır. Olgumuzda; yaşın ileri olması, antihipertansif tedavi olarak 3 farklı grup diüretik kullanılması ve idrar yolu enfeksiyonunun varlığı zehirlenmeyi kolaylaştıran etkenler olarak tanımlanmıştır. Bu olguda lityum kan düzeyi çok yüksek olmamasına rağmen risk faktörlerinin varlığında şiddetli nörolojik belirtilerin klinikte görülebileceğinin akılda tutulması gerektiği vurgulanmaktadır.

Anahtar Kelimeler

• Lityum
• Lityum Zehirlenmesi
• Bipolar Bozukluk
• Geriatrik

Kaynakça

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