혈액투석으로 호전된 유지용량에서 발생한 리튬 중독 1예
A case of lithium poisoning with a maintenance dose treated by hemodialysis
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초록
저자들은 안정적인 혈중농도로 리튬을 복용해 오던 환자에서 혈압조절을 위해 안지오텐신 수용체 차단제와 클로로티아지드 혼합제를 복용한 뒤 리튬 독성이 발생하여 혈액투석 후 호전된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Lithium is a commonly prescribed drug for bipolar disorder. Because of the narrow therapeutic range, lithium intoxication continues to be prevalent. Drugs that alter renal function such as ACEI, ARB, NSAIDS, and thiazide can increase the risk of chronic lithium toxicity even to stable patients. A 65-year old woman was admitted for hand tremor, cognitive impairment, and lethargy. A medical history included major depressive disorder, mitral stenosis, atrial fibrillation, and hypertension. Her prescription included lithium, quetiapine, digoxin, furosemide, and warfarin. She recently received Atacand Plus (candesartan plus thiazide) for hypertension. At the time of admission, the patient was drowsy and confused. The serum lithium level was 4.25 mEq/L. The patient received hydration. Due to neurologic complications and the degree of lithium toxicity, a total of three sessions of hemodialysis were performed, and the post-dialysis serum lithium level was 0.54 mEq/L. The neurologic symptoms recovered completely after a third dialysis session.(Korean J Med 72:95-99, 2007)
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