Acute kidney injury induced lithium toxicity with concomitant neuroleptic malignant syndrome.

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL BioMedicine-Taiwan Pub Date : 2024-09-01 eCollection Date: 2024-01-01 DOI:10.37796/2211-8039.1459
Yin Ye Lai, Normaizuwana Mohamed Mokhtar, Intan Nureslyna Samsudin, Subashini C Thambiah
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Abstract

Lithium, despite being an indispensable agent in the treatment of psychiatric disorders, has a narrow therapeutic index and needs to be carefully administered. Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication due to central dopaminergic blockade. This case report illustrates the challenges in lithium therapy particularly related to the development of NMS when further risk factors such as polypharmacy and dehydration are present. We report a case of a 50-year-old man with underlying bipolar affective disorder who was previously able to tolerate olanzapine and lithium well, however developed chronic lithium toxicity due to diminished lithium elimination in acute kidney injury following a two-week history of viral acute gastroenteritis. He also developed NMS which could either be triggered independently by olanzapine; lithium toxicity; or attributed by a synergistic combination from lithium and olanzapine which led to an enhanced neurotoxicity in an already unstable dopaminergic pathway. Fluid therapy and supportive care allowed the patient to recover, and he was discharged well with a lower potency neuroleptic with slow dose titration.

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急性肾损伤引起的锂中毒并发神经性恶性综合征。
锂虽然是治疗精神疾病不可或缺的药物,但其治疗指数较窄,需要谨慎施用。神经性恶性综合征(NMS)是一种罕见但可能致命的并发症,由中枢多巴胺能阻断所致。本病例报告说明了锂治疗所面临的挑战,尤其是在存在多种药物和脱水等其他风险因素的情况下发生 NMS 时。我们报告了一例患有双相情感障碍的 50 岁男性患者的病例,他之前能够很好地耐受奥氮平和锂,但在两周的病毒性急性胃肠炎病史后,由于急性肾损伤导致锂排出减少,从而出现了慢性锂中毒。他还出现了 NMS,这可能是由奥氮平、锂毒性或锂与奥氮平的协同作用引起的,导致本已不稳定的多巴胺能通路的神经毒性增强。输液治疗和支持性护理使患者得以康复,并在使用低效神经安定剂和缓慢滴定剂量的情况下顺利出院。
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来源期刊
BioMedicine-Taiwan
BioMedicine-Taiwan MEDICINE, GENERAL & INTERNAL-
CiteScore
2.80
自引率
5.90%
发文量
21
审稿时长
24 weeks
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