크레아티닌 정상 수준의 환자에서 리튬 유지 치료 중 발생한 리튬 독성 1예
A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment
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유지용량으로 리튬을 복용해오던 환자에서 신기능 부전의지표로 사용될 수 있는 크레아티닌 수치가 정상 범위에 해당하였지만 신기능 저하 및 리튬 독성이 발생하였다는 점에서,본 증례는 리튬 치료 환자의 독성 발생 모니터링에 있어서 시사하는 바가 있다. 신기능 부전은 체내의 리튬 축적을 야기하여 리튬 독성을 일으키고, 리튬 독성에 의해 신기능 저하가더욱 악화될 수 있다. 따라서 리튬 복용 환자에서는 주기적인신기능 모니터링이 필요하다. 혈청 크레아티닌 수치가 정상범위에 있더라도 기저치에서 상승되어 있다면 신장 기능의변화를 암시할 수 있다. 따라서 크레아티닌의 절대적인 수치뿐 아니라 기저치에서의 상승 정도와 속도가 신기능 부전을예측하는데 중요할 것으로 보인다.
Abstract
Lithium is a widely used drug for treatment of bipolar disorder. Because of its narrow therapeutic range and renal toxicity, most clinical guidelines recommend regular monitoring of serum lithium level and kidney function for patients taking lithium. We report on a case of a 20 year-old man with occurrence of lithium toxicity after more than one year of lithium maintenance therapy with daily lithium intake of 900 mg. His serum creatinine level was within normal range at admission and elevated compared to his baseline, but still within normal range when lithium toxicity occurred. Acute kidney injury associated with dehydration, analgesics, and nephrotoxic effect of lithium might be a risk factor of lithium toxicity. This case showed the importance of thorough monitoring of serum creatinine level change even if its elevated result is within normal range in observing renal function of patients treated with lithium.
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