Schwere Lithiumintoxikationen bei normalen Serumspiegeln

 

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Zusammenfassung

Anliegen Unser Ziel ist es, Faktoren zu identifizieren, die das Risiko einer Lithiumintoxikation trotz normaler Serumspiegel erhöhen. Methode Wir beschreiben zwei eigene Fälle und bewerten diese im Kontext der Literatur. Ergebnisse Alter, Begleiterkrankungen und psychopharmakologische Komedikation erhöhen das Risiko einer Lithiumintoxikation bei normalen Serumspiegeln. Diskussion Bei älteren, multimorbiden Patienten sollte eine engmaschige klinische Kontrolle inklusive Spiegelbestimmung und EEG erfolgen, bei klinischen Anzeichen der Intoxikation sollte auch bei unauffälligen Spiegeln ein Absetzen erwogen werden.

Abstract

Objective Lithium is known to be neurotoxic at higher serum levels. In rare cases patients develop symptoms of intoxication or full blown intoxications even when lithium levels are normal. Our aim was to detect predicting factors of lithium neurotoxicity at normal serum lithium levels in order to allow prevention of those constellations. Methods We report two cases of severe lithium intoxications at normal serum lithium levels and review the current literature concerning lithium neurotoxicity at normal serum levels. Results It appears that the probability of developing signs of lithium intoxications in patients treated with lithium is increased with advanced age, co-morbidity with pre-existing neurological or other general diseases, especially those associated with fever, and in combination with the use of antipsychotics, antidepressants or mood stabilizers. The serum lithium level does not necessarily detect an intoxication. Conclusions In patients developing signs of intoxication under lithium therapy, further investigations should include serum levels and an EEG. Because intoxications can occur even in normal serum levels, discontinuation of lithium medication should be taken into account on the basis of clinical signs of intoxication.

Literatur

• 1 Cade J F. Lithium salts in the treatment of psychotic excitement. 1949.  Bull World Health Organ. 2000;  78 518-520
  PubMedGoogle Scholar
• 2 Gaebel W, Falkai P. Behandlungsleitlinie Affektive Erkrankungen. Darmstadt; Steinkopff 2001
  Google Scholar
• 3 Speirs J, Hirsch S R. Severe lithium toxicity with „normal” serum concentrations.  Br Med J. 1978;  1 815-816
  PubMedGoogle Scholar
• 4 Habib M, Khalil R, le Pensec-Bertrand D, Ali-Cherif A, Bongrand M C, Crevat A. Persistent neurological syndrome after treatment with lithium salts. Toxicity of the lithium-neuroleptic combination?.  Rev Neurol (Paris). 1986;  142 61-64
  PubMedGoogle Scholar
• 5 Bischof F, Melms A, Fetter M. Persistent cerebellar deterioration in a patient with lobar pneumonia under lithium, carbamazepine, and trifluperidol treatment.  Eur Psychiatry. 1999;  14 175-176
  CrossrefPubMedGoogle Scholar
• 6 Normann C, Brandt C, Berger M, Walden J. Delirium and persistent dyskinesia induced by a lithium-neuroleptic interaction.  Pharmacopsychiatry. 1998;  31 201-204
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Frye M A, Ketter T A, Leverich G S, Huggins T, Lantz C, Denicoff K D. et al . The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study.  J Clin Psychiatry. 2000;  61 9-15
  PubMedGoogle Scholar
• 8 Kondziela J R. Extreme lithium intoxication without severe symptoms.  Hosp Community Psychiatry. 1984;  35 727-728
  PubMedGoogle Scholar
• 9 Kato T, Inubushi T, Takahashi S. Relationship of lithium concentrations in the brain measured by lithium-7 magnetic resonance spectroscopy to treatment response in mania.  J Clin Psychopharmacol. 1994;  14 330-335
  PubMedGoogle Scholar
• 10 Vredeveld C J, Morre H H. Lithiumneurotoxizitat im höheren Lebensalter. Zwei kasuistische Berichte mit einer Literaturubersicht.  Nervenarzt. 1983;  54 377-380
  PubMedGoogle Scholar
• 11 Verdoux H, Bourgeois M L. A case of lithium neurotoxicity with irreversible cerebellar syndrome.  J Nerv Ment Dis. 1990;  178 761-762
  PubMedGoogle Scholar
• 12 Sachs G S, Grossman F, Ghaemi S N, Okamoto A, Bowden C L. Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety.  Am J Psychiatry. 2002;  159 1146-1154
  CrossrefPubMedGoogle Scholar
• 13 Boker H, Brandenberger M, Schopper C. Neurotoxische Enzephalopathie unter Kombinationsbehandlung mit Lithium und Risperidon bei einer Patientin mit schizoaffektiver Störung.  Psychiat Prax. 2007;  34 38-41
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Lambreva E, Vecellio M, Wieser H G, Buddeberg C. Neurotoxic encephalopathy caused by neuroleptics and lithium.  Nervenarzt. 2005;  76 756-759
  CrossrefPubMedGoogle Scholar
• 15 Miodownik C, Hausmann M, Frolova K, Lerner V. Lithium intoxication associated with intramuscular ziprasidone in schizoaffective patients.  Clin Neuropharmacol. 2005;  28 295-297
  CrossrefPubMedGoogle Scholar
• 16 Redmond J R, Jamison K L, Bowden C L. Lamotrigine combined with divalproex or lithium for bipolar disorder: a case series.  CNS Spectr. 2006;  11 915-918
  PubMedGoogle Scholar
• 17 Goodwin F K. Rationale for using lithium in combination with other mood stabilizers in the management of bipolar disorder.  J Clin Psychiatry. 2003;  64, Suppl 5 18-24
  PubMedGoogle Scholar
• 18 Omata N, Murata T, Omori M, Wada Y. A patient with lithium intoxication developing at therapeutic serum lithium levels and persistent delirium after discontinuation of its administration.  Gen Hosp Psychiatry. 2003;  25 53-55
  PubMedGoogle Scholar
• 19 Gallinat J, Boetsch T, Padberg F, Hampel H, Herrmann W M, Hegerl U. Is the EEG helpful in diagnosing and monitoring lithium intoxication? A case report and review of the literature.  Pharmacopsychiatry. 2000;  33 169-173
  PubMedGoogle Scholar
• 20 Zschocke S. Klinische Elektroenzephalographie. Berlin, Heidelberg, New York; Springer-Verlag 2002
  Google Scholar

Dr. med. Wolfram Kawohl

Psychiatrische Universitätsklinik Zürich

Lenggstraße 31

Postfach 1931

8032 Zürich, Schweiz

Email: wolfram.kawohl@puk.zh.ch