Schwere Lithiumintoxikationen bei normalen Serumspiegeln

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.

Schlüsselwörter

Lithiumintoxikation - Serumspiegel - EEG - Neurotoxizität - Polypharmazie

Key words

lithium intoxication - serum level - EEG - neurotoxicity - polypharmacy

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