Lithium Toxicity: Coarse Tremor, Kusokonezeka, Kutaya madzi m'thupi, ndi NSAID Interaction Triage¶

Lithium (yomwe imatchedwa lithium carbonate kapena lithiamu citrate pansi pa mayina monga Eskalith, Lithobid, Priadel, ndi Camcolit) ndiyomwe imapangitsa kuti pakhale vuto la kukhumudwa komanso kusamva mankhwala. Komabe, lithiamu ndi cation monovalent (Li+) yokhala ndi zenera laling'ono kwambiri lochizira (0.6 to 1.2 mEq/L kapena mmol/L) ndi zero hepatic metabolism: 100 peresenti ya lithiamu yomwe imalowetsedwa imachotsedwa kudzera mu impso pamodzi ndi sodium ndi madzi. Chifukwa impso ya munthu imagwira lithiamu mofanana ndi sodium mu proximal aimpso tubules, chilichonse chomwe chimachotsa sodium m'thupi kapena madzi, kapena chimachepetsa kuthamanga kwa magazi a aimpso, chimanyengerera impso kuti zilowetsenso lithiamu m'magazi. Ngati wina akumwa lifiyamu ayamba kunjenjemera m'manja, kuyankhula mopanda mphamvu, kugwedezeka kosakhazikika (ataxia), chisokonezo, kugwedezeka kwa minofu, kapena kusanza kosalekeza ndi kutsekula m'mimba, imbani nambala yanu yadzidzidzi (911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom) manambala angozi chikwatu nthawi yomweyo, ndikuwunikanso poyizoni thandizo loyamba, gwira thandizo loyamba,ndi kudya poizoni ndi kutaya madzi m'thupi.

Chomwe chimapangitsa poizoni wa lithiamu kukhala wowopsa kwambiri ndikuti kuwopsa kwanthawi zonse kapena kwakanthawi kochepa (pomwe wodwala akumwa mankhwala ake a tsiku ndi tsiku amataya madzi chifukwa cha thukuta la chilimwe, kachilombo ka m'mimba, kudya zakudya zopanda mchere wambiri, kapena kuyamba kumwa mankhwala osokoneza bongo NSAID monga ibuprofen/naproxen, ACE inhibitor imayambitsa kuwononga kwambiri muubongo, kapena kumachepetsa kwambiri misinkhu** yamagazi kuposa kumwa mapiritsi owopsa a nthawi imodzi mwa munthu wopanda lifiyamu. Muzowopsa kwambiri, lithiamu yadzaza kale minofu ya muubongo, zomwe zimapangitsa chisokonezo, kukomoka, chikomokere, komanso kuvulala kosasinthika kwa ubongo komwe kumadziwika kuti ** SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity)** ngati sichizindikirika ndikuchotsedwa mwachangu ndi intravenous normal saline hydration*.

Chitani izi tsopano¶

1. ** Itanani chithandizo chamankhwala mwadzidzidzi ndi kuwongolera poizoni nthawi yomweyo **: Imbani 911 (US ndi Canada), 112 (EU), kapena 999 (UK) nthawi yomweyo ngati munthu akutenga lithiamu akuyamba kunjenjemera koopsa, mawu osamveka bwino, kupunthwa kapena kulephera kuyenda molunjika, kugona, chisokonezo, kugwedezeka kwa minofu, kapena kugunda kwa pial, kapena ngati wina wagwidwa ndi cholinga. Ku United States, imbaninso Poison Control pa 1-800-222-1222.
2. **Gwiritsaninso milingo ina yonse ya lithiamu ndikusiya kuyanjana ndi mankhwala nthawi yomweyo *: Osaperekanso mlingo wina wa lithiamu. Nthawi yomweyo siyani mankhwala aliwonse ophatikizika NSAID zochepetsa ululu (ibuprofen [Advil, Motrin], naproxen [Aleve], celecoxib, meloxicam, diclofenac), diuretics (hydrochlorothiazide, chlorthalidone, furosemide), kapena *ACE inhibitors ramiprispris, ARB, ARB, L. valsartan), ndipo sonkhanitsani botolo lililonse lamapiritsi kuti mupereke kwa dokotala wadzidzidzi.
3. **Zindikirani nthawi yeniyeni ya nthawi ya mlingo wotsiriza wa lithiamu ndi mapangidwe **: Yang'anani botolo kuti muwone ngati mapiritsi ali ** kumasulidwa mwamsanga ** kapena ** kumasulidwa kosalekeza / kumasulidwa kowonjezereka ** (monga Lithobid, Eskalith CR, kapena Priadel). Chifukwa lithiamu yotulutsidwa mosalekeza imatenga pang'onopang'ono kupitilira maola 6 mpaka 12+ ndipo imatha kulowa m'mimba, madotolo amafunikira nthawi yeniyeni yoyamwa kuti ayitanitsa kuchuluka kwa magazi maola awiri kapena anayi aliwonse.
4. OSATI kupatsa madzi opanda mchere ochuluka kapena kusanza: Musamakakamize kutseka pakamwa kapena kusanza. Ngati munthuyo ali maso, tcheru, ndipo amatha kumeza bwinobwino popanda kusanza pamene akudikirira chithandizo chamankhwala, kumwa kwa oral rehydration solution kapena mchere wamchere kumakhala kotetezeka kusiyana ndi madzi opanda madzi, chifukwa kawopsedwe ka lithiamu kaŵirikaŵiri amachititsa nephrogenic shuga insipidus (mkodzo waukulu wosungunuka) ndi kuchepa kwa sodium kumalandira chithandizo chopanda 9%* m'chipatala.
5. **Tetezani munthuyo kuti asagwe ndikukonzekera kugwidwa mwadzidzidzi **: Chifukwa chakuti lithiamu imayang'ana kwambiri cerebellum ndi motor cortex, odwala amayamba ataxia (kutaya bwino) ndipo mwadzidzidzi **myoclonic jerks ** yomwe imapita mofulumira ku tonic-clonic khunyu. Atsogolereni munthuyo kuti agone pabedi, pabedi, kapena pansi kutali ndi mipando yolimba. Ngati khunyu layamba, atembenuzireni pambali pawo pamene akuchira ndipo osayika kalikonse mkamwa mwawo.
6. Chenjezani ogwira ntchito m'chipatala kuti asamapereke makala opangidwa ndi lithiamu okha: Mosiyana ndi mankhwala ena onse, lithiamu ndi ayoni yachitsulo yolipiridwa (Li+) zomwe SIMAMAngirira ku makala. Kuti atulutse mopitirira muyeso wa lithiamu, madipatimenti adzidzidzi amagwiritsa ntchito Whole-Bowel Irrigation (WBI) ndi polyethylene glycol electrolyte solution m'malo mwake.

Mtengo wachigamulo: Acute, acute-on-chronic, komanso osatha a lithiamu toxicity triage¶

flowchart TD
    Start["Kuganiziridwa kuti Lithium Toxicity (Wogwiritsa Ntchito Tsiku ndi Tsiku Ali ndi Zizindikiro Zatsopano KAPENA Kuchulukira Kwa Mapiritsi)"] --> CallEMS["Imbani 911/112/999 ndi Poizoni Control; Gwirani Lithium, NSAIDs, Diuretics, ndi ACEi/ARBs"]
    CallEMS --> Classify["Gawani Chitsanzo: Acute (Naive) vs Acute-on-Chronic vs Chronic Accumulation"]

    Classify -->|Acute or Acute-on-Chronic Ingestion| GI_Rule["Chipatala cha GI Decontamination: OSAGWIRITSA NTCHITO Makala Ogwiritsidwa Ntchito (Samanga Lithium); Gwiritsani Ntchito Yothirira M'matumbo Athunthu (PEG-ELS) Potulutsa-Kutulutsa > Mapiritsi 20-30"]
    Classify -->|Chronic Toxicity (Triggered by Dehydration / AKI / NSAIDs / Thiazides)| NeuroCheck["Unikani Kuvuta kwa Mitsempha (Chabwino -> Coarse Tremor, Ataxia, Dysarthria, Myoclonus, Delirium, Khunyu)"]
    GI_Rule --> NeuroCheck

    NeuroCheck --> StartIV["Kutsitsimutsidwa Kwachipatala Mwamsanga: Intravenous 0.9% Saline Yachibadwa (Kubwezeretsani GFR ndi Proximal Tubular Sodium Delivery) + Monitor for Nephrogenic Diabetes Insipidus (Hypernatremia)"]
    StartIV --> SerialLabs["Jambulani STAT Serum Lithium (mu NON-Lithium-Heparin Tube), Renal Panel (Creatinine/BUN), Serum Sodium, ndi 12-Lead ECG; Bwerezani Mulingo wa Lithium Maola 2-4 aliwonse"]

    SerialLabs --> EXTRIP_Check{"Chongani EXTRIP Criteria for Emergency Intermittent Hemodialysis"}

    EXTRIP_Check -->|1. ANY Severe Neurological Symptoms (Seizures, Coma, Delirium, Severe Ataxia) Regardless of Lithium Level| Dialysis["YAMBIRITSANI NTCHITO YOPHUNZITSIDWA YOPHUNZITSIRA HEMODIALYSIS MNTHAWI YOMWEYO"]
    EXTRIP_Check -->|2. Serum Lithium > 4.0 mEq/L with Renal Impairment OR > 5.0 mEq/L in Any Patient| Dialysis
    EXTRIP_Check -->|3. Expected Time to Reach Lithium < 1.0 mEq/L Exceeds 36 Hours| Dialysis
    EXTRIP_Check -->|Mild Symptoms + Preserved Kidney Function| SalineWatch["Pitirizani IV Normal Saline Hydration + Seri Lithium Levels Mpaka <1.0 mEq/L ndi Neurologically Baseline"]

    Dialysis --> ReboundCheck["Yang'anirani Seramu Lithium Maola 6-12 Pambuyo pa Dialysis kwa Rebound Elevation (Monga Lithiamu Imagawiranso Kutuluka mu Ubongo/Intracellular Tissue kulowa Magazi); Bwerezani Dialysis ngati Pakufunika"]

Pathophysiology: Momwe Impso Zimasokoneza Lithiamu ndi Sodium¶

Kuti mumvetse chifukwa chake zochitika za tsiku ndi tsiku, monga mlungu wotentha wa chilimwe, vuto la m'mimba la maola 24, chakudya chochepa cha sodium-sodium, kapena kugula botolo la Advil kwa bondo lophwanyika, akhoza kutumiza wodwala lithiamu wokhazikika m'chipinda cha odwala kwambiri mkati mwa maola 72, muyenera kumvetsetsa ** proximal tubular sodium-lithium handling **:

1. Proximal Tubule Sodium-Substitution Trap¶

Lithiyamu (Li+) imakhala pamwamba pa sodium (Na+) mu Gulu 1 (zitsulo za alkali) za tebulo la periodic. Chifukwa lithiamu sichimapangidwa ndi chiwindi ndipo sichimangirira mapuloteni amagazi (0% protein binding), 100 peresenti ya lithiamu m’mwazi imasefedwa momasuka pa glomerulus ya impso kulowa m’mitsempha ya aimpso.

M'mikhalidwe yabwinobwino, yokhala ndi madzi ambiri: - ** 70 peresenti mpaka 80 peresenti ya lithiamu yowonongeka imabwezeretsedwanso m'magazi mu Proximal Convoluted Tubule (PCT) ** pamodzi ndi sodium ndi madzi, kusiya 20 peresenti mpaka 30 peresenti kuti itulutsidwe mumkodzo. - Nthawi zonse thupi likamva kuchepa kwa sodium, kutaya madzi m'thupi, kapena kuchepa kwaimpso (kuchokera kutuluka thukuta, kusanza, kutsekula m'mimba, kutentha thupi, kulephera kwa mtima, kapena matenda enaake), impso zimayambitsa dongosolo la renin-angiotensin-aldosterone (RAAS) kuti lipulumutse mwachangu ma ion aliwonse a sodium ndi dontho lamadzi mu proximal tubule. - Chifukwa ma proximal tubular transporters (NHE3 ndi paracellular pathways) sangathe kusiyanitsa pakati pa sodium (Na+ndi lithiamu (Li+), impso zokhala ndi njala ya sodium zimayambiranso **pafupifupi 90 peresenti mpaka 99 peresenti ya lithiamu yosefedwa ** pamodzi ndi sodium. Lithium excretion imatsikira pafupi ndi ziro, ndipo wodwala tsiku ndi tsiku mlingo wa lithiamu umasanduka chipale chofewa m'magazi apoizoni ndi muubongo.

2. "Triple Whammy" Kuyanjana kwa Mankhwala Omwe Amalepheretsa Lithium Clearance¶

Magulu atatu amankhwala wamba amayambitsa kawopsedwe ka lithiamu mwa kuphwanya kusefera kwa glomerular kapena kukakamiza proximal tubular lithiamu reabsorption:

3. Nephrogenic Diabetes Insipidus Vicious Cycle¶

Kuchiza kwa lithiamu komwe kumawononga luso la impso kuyika mkodzo: - Lithiamu imalowa m'maselo akuluakulu a njira yotolera aimpso kudzera mu njira za epithelial sodium (ENaC) ndikuletsa intracellular glycogen synthase kinase-3 beta ndi adenylyl cyclase. - Izi zimapangitsa kuti njira yosonkhanitsira ikhale yosakhudzidwa ndi Antidiuretic Hormone (ADH / Vasopressin), kuchepetsa ** Aquaporin-2 madzi ngalande ** ndi kuchititsa Acquired Nephrogenic Diabetes Insipidus (NDI) mpaka 20 peresenti mpaka 40 peresenti ya ogwiritsa ntchito lithiamu kwa nthawi yaitali. - Odwala omwe ali ndi lithiamu-induced NDI amatulutsa madzi ambiri (3 mpaka 8+ malita patsiku) a mkodzo wosungunuka, wamadzi (polyuria) ndipo ayenera kumwa mosalekeza (polydipsia) kuti akhalebe ndi madzi. Ngati wodwalayo agwira chotupa cha m'mimba, asokonezeka pang'ono, agonekedwa m'chipatala, kapena sangathe kupeza madzi kwa *12 kwa maola 24 , amataya malita a madzi aulere kudzera mkodzo wawo, akukula mofulumira ** kutaya kwambiri madzi m'thupi, hypernatremia (high blood sodium), kuvulala kwa impso, ndi fulminant lithium neurotoxicity.

Mitundu itatu ya Poyizoni ya Lithium ndi Kuyimitsa Kuopsa Kwachipatala¶

1. Kuyerekeza Poyizoni wa Lithiyamu Woopsa, Wovuta Kwambiri, ndi Wosatha¶

2. Kukula kwa Mitsempha: Kuchokera ku Kunjenjemera Kwabwino Kwambiri mpaka Kugwedezeka Kwambiri ndi CHETE¶

Kodi mumasiyanitsa bwanji pakati pa zotsatira zosavulaza za lithiamu wamba watsiku ndi tsiku ndi kawopsedwe weniweni wazachipatala?

1. Zotsatira Zabwino Zochizira (Mlingo Wabwino Kwambiri wa Lithium 0.6 to 1.2 mEq/L):
2. Kunjenjemera kwabwino kwapambuyo/kuchitapo kanthu: Kusala kudya (8 to 12 Hz), zosaoneka bwino, kunjenjemera kofanana kwa nsonga zotambasula zala (zofanana ndi kugwedezeka kwa caffeine) zomwe sizimalepheretsa kunyamula kapu kapena kulemba, kutsagana ndi kulankhula kwachibadwa, kuyenda bwino, ndi kulingalira bwino.
3. Kuchepa kwa Lithium Toxicity (Mwachidziwikire 1.5 to 2.5 mEq/L mu Toxicity Yosatha):
4. Kunjenjemera kwa dzanja losakhazikika komanso lamanja: Kunjenjemera kwa chala kumachedwetsa pang'onopang'ono ndipo kumakhala **kunjenjemera kowoneka mokulirapo, kogwedera, koopsa ** komwe kumakhudza kupumula ndi kuyenda koyenera, kutaya madzi kuchokera mugalasi, kugwetsa zida zasiliva, kapena kupangitsa kuti zolembera zisalembedwe.
5. Cerebellar Ataxia ndi Dysarthria: Chifukwa lithiamu imatulutsa poizoni m'maselo a Purkinje mu cerebellum, munthuyo amayamba kuyenda ndikuyenda mozungulira, modzidzimutsa, kuledzera (ataxia), sluring mawu awo (**dysarthria ), ndi kusonyeza kusasamala kwa maso () .
6. Neuromuscular Hyperexcitability: Kufooka kwa minofu, hyperactive deep tendon reflexes (hyperreflexia), kutengeka kwa minofu (kugwedezeka kwapansi pa khungu), ndi kugwedezeka kwadzidzidzi ngati kugwedezeka kwa minofu (** myoclonus **).
7. Early Encephalopathy: Ulesi, mphwayi, kupindika, kusokonekera, kapena kuvutika kupeza mawu.
8. Kuopsa Kwambiri kwa Lithium (Mwachidziwikire > 2.5 mEq/L Zosatha, Kapena Mulingo Uliwonse Wokhala ndi Encephalopathy):
9. Choreoathetosis ndi Parkinsonian/Extrapyramidal Rigidity: Kulimba kwa minofu ya Cogwheel, kugwedezeka kwa miyendo, komanso kulephera kuyimirira kapena kukhala.
10. Delirium, Stupor, ndi Coma: Chisokonezo chachikulu chomwe chikukulirakulira mpaka kusalabadira.
11. Kugwidwa kwa Tonic-Clonic Nthawi Zonse ndi Epilepticus Mkhalidwe Wosagwedezeka: Lithium imatsitsa chigawo cha cerebral cortex.
12. ** Kusintha kwa Mayendedwe a Mtima **: Ngakhale kuti kumangidwa kwa mtima sikofala kwambiri kusiyana ndi kuvulala kwa ubongo, lithiamu imalowa m'malo mwa potaziyamu ya intracellular mu minofu ya mtima, kutulutsa ** mafunde ophwanyidwa kapena osinthika a T ** (kutsanzira hypokalemia), ** kusokonezeka kwa node ya sinus / sinus syndrome (bradycardia yoopsa kapena sinoatrial block) * *, QG, QG, QG, QG, QG, QG, QG
13. Chiwopsezo Chosatha Kuwonongeka Kwa Ubongo: SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity):
14. Pafupifupi 10 peresenti ya odwala omwe amadwala kwambiri kwa nthawi yayitali lifiyamu kawopsedwe, makamaka ngati akutsatiridwa ndi **kutentha kwambiri (hyperthermia) **, kutaya madzi m'thupi, kapena kugwiritsa ntchito nthawi yomweyo antipsychotic, lithiamu imayambitsa kuwonongeka kosatha ndi kuwonongeka kwa maselo a cerebellar Purkinje.
15. Ngakhale lithiamu yonse itachotsedwa m'thupi, ozunzidwa ndi ** SILENT ** amasiyidwa ndi ** osatha, moyo wonse wa cerebellar ataxia (kulephera kuyenda popanda woyenda kapena chikuku), kusanthula mawu osamveka bwino, kunjenjemera kosalekeza, nystagmus, kapena dementia * * kwa miyezi yambiri mpaka zaka zambiri. Kuzindikirika mwachangu, kuwongolera kutentha thupi, ndi hemodialysis yoyambirira ndi njira zokhazo zopewera CHETE.

Hospital Emergency Management: Pitfalls Lab, GI Decontamination, IV Saline, ndi Hemodialysis¶

1. Msampha wa Machubu a Magazi: Musamajambule Mulingo wa Lithiamu mu chubu cha Green-Top Lithium-Heparin¶

2. Kuchotsa m'mimba: Chifukwa Chake Makala Oyatsidwa Amalephereka Ndi Nthawi Yomwe Ayenera Kuthirira M'matumbo Athunthu.¶

• OSATI KUPEREKA Makala Ogwiritsa Ntchito Mmodzi wa Lithium Wogwiritsa Ntchito Mmodzi: Makala oyaka amatchinjiriza mamolekyu akuluakulu amankhwala opangidwa ndi kaboni kudzera mumphamvu za nonpolar van der Waals. Chifukwa lithiamu ndi yaying'ono, yopangidwa ndi zitsulo zachitsulo (Li+), ** Makala oyendetsedwa amakhala ndi zero kumangiriza mphamvu ya lithiamu** (amaperekedwa pokhapokha ngati wodwalayo amwa mankhwala ena achilengedwe monga antidepressant kapena antipsychotic).
• Sodium Polystyrene Sulfonate (Kayexalate) SILIKUNKHWIKIDWA: Ngakhale kuti mbiri yakale idaphunziridwa kusinthana ndi sodium ya lithiamu m'matumbo, akatswiri a toxicologists amalangiza motsutsana ndi Kayexalate yachizolowezi chifukwa imafuna Mlingo waukulu womwe umayambitsa hypokalemia, hypernatremia, ndi matumbo necrosis.
• Kuthirira M'matumbo Onse (WBI) kwa Lithium Yotulutsidwa Mokhazikika: Chifukwa mapiritsi a lithium carbonate (monga Lithobid kapena Priadel) amayamwa pang'onopang'ono kupitilira maola 12 mpaka 24+ ndipo amatha kulumikizana m'matumbo am'mimba (*pharmacobet) kwa masiku angapo, Kuthirira ** ndi ** polyethylene glycol electrolyte solution (PEG-ELS pa 1.5 mpaka 2 L / ola kudzera mu chubu cha nasogastric) ** akulimbikitsidwa kwa odwala maso, otetezedwa ndi mpweya wotuluka pambuyo pa kumeza kwakukulu (kawirikawiri ** mapiritsi oposa 20 mpaka 30 kapena> 50 mpaka 80 mpaka 80 mg-kg) ya lithiamu-kg.
• Milingo ya Lithium ya Seriyo Maola 2 mpaka 4 aliwonse: Osadalira mulingo umodzi wovomerezeka wa lithiamu mutatha kumwa movutikira kapena movutikira. Chifukwa mayamwidwe otulutsidwa mosadukiza amakhala pang'onopang'ono, milingo ya lithiamu ya seramu iyenera kuyang'aniridwanso **maola 2 mpaka 4 aliwonse ** mpaka mulingowo utafika pachimake komanso kutsika mpaka momwe wakhalira.

3. Kutsitsimula kwa Mtsempha Wamadzimadzi (0.9% Saline Yachibadwa, OSATI Yokakamiza Loop Diuresis)¶

Mwala wapangodya wachipatala kwa wodwala aliyense yemwe ali ndi kawopsedwe ka lithiamu ndi kubwezeretsa voliyumu yamkati, glomerular filtration rate (GFR), ndi proximal tubular sodium delivery: - Yambitsani Mtsempha 0.9% Saline Yachibadwa (0.9% NaCl) Nthawi yomweyo: Perekani bolus yoyamba ya ** 1,000 mpaka 2,000 mL ya 0.9% Saline Yachibadwa ** ngati wodwalayo ali ndi mphamvu yowonjezera kapena hypotensive, kutsatiridwa ndi kulowetsedwa kosalekeza kwa ** 1.5 ku 2 nthawi yosamalira bwino (nthawi zambiri 150 mpaka 200 mL * 1 ola, kutulutsa kwa mkodzo kwa akuluakulu * 5 ola. 3 mL/kg/ola**. - Mmene Saline Yachibadwa Imatsegulira Renal Lithium Clearance: Kupereka sodium wochuluka (Na+) ndi madzi opita ku impso amazimitsa dongosolo la renin-angiotensin-aldosterone ndikusefukira proximal convoluted tubule ndi ayoni a sodium, kuletsa impso kuti zisatengenso lithiamu ndikulola lithiamu kutuluka mumkodzo. - Penyani Hypernatremia kuchokera ku Nephrogenic Diabetes Insipidus: Onani seramu ya sodium (Na+) maola 4 aliwonse. Ngati wodwala ali ndi vuto la lithium-induced nephrogenicdiabetes insipidus (kutulutsa mkodzo wosungunuka, wopanda mchere), kulowetsa 0.9% Saline Yachibadwa yokha popanda m'malo mwa madzi aulere imatha kuyendetsa mwachangu seramu ya sodium pamwamba pa 150 mpaka 160 mEq/L (yoopsa hypernatremia) ndi kusokonezeka kwa ubongo, Odwala omwe ali ndi NDI ndi kukwera kwa seramu ya sodium, madokotala amasintha kapena amalowetsa madzimadzi a hypotonic.0.45% Half-Normal Saline kapena D5W) ndipo atha kupereka amiloride (potassium-sparing diuretic yomwe imatsekereza epithelial sodium channels).ENaC] mu njira yosonkhanitsa, kuteteza lithiamu kulowa m'maselo akuluakulu ndikuwongolera NDI). - Musagwiritse Ntchito Loop Diuretics (Furosemide) kapena Thiazides Kuti "Kukakamiza Diuresis": Kupatsa furosemide (Lasix), bumetanide, kapena mannitol "kukakamiza kutulutsa mkodzo" kwenikweni **kumachepetsa sodium ndikuchepetsa kuchotsedwa kwa lithiamu **, kukulitsa kawopsedwe ka lithiamu.

4. Emergency Intermittent Hemodialysis (EXTRIP Workgroup Consensus Guidelines)¶

Chifukwa lithiamu ili ndi kulemera kochepa (7 Daltons), kumanga zero mapuloteni (0%), ndi gawo laling'ono la magawo (0.7 to 0.9 L/kg), lithiyamu ndi imodzi mwa poizoni omwe amachulukidwa kwambiri muzamankhwala.

• Intermittent Hemodialysis (IHD) vs. CRRT: Kuchita bwino kwambiri Intermittent Hemodialysis (IHD) imachotsa lithiamu nthawi zinayi mofulumira kuposa Continuous Renal Replacement Therapy (CRRT / CVVHDF) ndipo nthawi zonse ndiyo njira yabwino yopezera chilolezo choyamba.
• Zizindikiro Zogwirizana Zadzidzidzi Hemodialysis mu Lithium Poisoning:
• Zizindikiro Zowopsa Zaubongo Pamulingo WONSE wa Lithiamu: Chikomokere, kukomoka, kusokoneza moyo wowopsa, kapena delirium/encephalopathy/ataxia, mosasamala kanthu kuti mulingo wa lithiamu wa seramu ndi 1.8 mEq/L kapena 5.0 mEq/L.
• Serum Lithium> 4.0 mEq/L mwa wodwala aliyense yemwe ali ndi impso yosokonekera (kuvulala kwaimpso kapena matenda aakulu a impso).
• Seramu Lithium> 5.0 mEq/L mwa wodwala aliyense, ngakhale ali ndi impso zabwinobwino komanso ziro (monga atangomwa kwambiri).
• **Kuwonetsetsa Kwanthawi yayitali **: Ngati chisokonezo chilipo, KAPENA ngati nthawi yoyembekezeredwa yofunikira kuti muchepetse kuchuluka kwa lithiamu mu seramu pansi pa 1.0 mEq/L yokhala ndi IV hydration yabwino imapitilira maola 36.
• **Zochitika za Post-Dialysis "Rebound" **:
• Hemodialysis imachotsa mwachangu lithiamu kuchokera mu **bloodstream **, ndikutsitsa mulingo wa lithiamu m'madzi pansi. 1.0 mEq/L pofika kumapeto kwa gawo la dialysis la maola 6.
• Komabe, chifukwa lithiamu imatuluka mu zigawo za intracellular (ubongo ndi minofu) pang'onopang'ono, **6 mpaka maola 12 mutayimitsa makina a dialysis , lithiamu imatuluka kuchokera ku minofu kubwerera m'magazi (ndi mapiritsi aliwonse otsala otulutsidwa m'matumbo akupitiriza kuyamwa), kuchititsa ** post-dialysis rebound spike mu serum lithiamu.
• Choncho, madokotala nthawi zonse amayang'ananso seramu lithiamu ** 6 kwa maola 12 pambuyo pa hemodialysis ** ndipo nthawi zambiri amachita ** mobwerezabwereza magawo a hemodialysis ** (kapena kusintha kwa ** CRRT ** pambuyo pa gawo loyamba la IHD) mpaka mlingo wa lithiamu wogawanika umakhalabe pansi pa ** 1.0 mEq / L ** ndipo wodwalayo akupita patsogolo. (Dziwani: Ngakhale magazi atakhala abwinobwino, minyewa imabwerera m'mbuyo pakadutsa masiku angapo chifukwa ubongo umayenda pang'onopang'ono).

Mndandanda wa Kupewa Kwa Odwala Amene Akutenga Lithium Yatsiku ndi Tsiku¶

• Musatengere mankhwala a ibuprofen (Advil, Motrin) kapena naproxen (Aleve): Sungani ** acetaminophen (paracetamol / Tylenol)** kunyumba chifukwa cha kupweteka kwa mutu, kutentha thupi, kapena kupweteka kwa minofu (ngati mulibe matenda a chiwindi), monga acetaminophen sichiletsa chilolezo cha renal lithium.
• ** Tsatirani "Malamulo a Tsiku Lodwala"**: Ngati muyamba kusanza, kutsegula m'mimba, kutentha thupi kwambiri, kapena kutuluka thukuta chifukwa cha kutentha kwachilimwe kapena masewera olimbitsa thupi, **siyani kumwa mapiritsi anu a lithiamu kwakanthawi **, kumwa madzi okhala ndi electrolyte, ndipo itanani dokotala wanu kapena chipatala tsiku lomwelo kuti akuyeseni magazi a lithiamu ndi impso.
• **Sungani mchere wanu wa tsiku ndi tsiku (sodium) wosasunthika **: Musayambe kudya mwadzidzidzi zakudya za sodium kapena kusala kudya popanda dokotala kusintha mlingo wanu wa lithiamu poyamba, chifukwa kugwa kwadzidzidzi kwa mchere wa zakudya nthawi yomweyo kumapangitsa impso zanu kusunga lithiamu.
• Kumbutsani dokotala aliyense, dotolo wamano, ndi wamankhwala kuti mutenge lithiamu: Musanayambe mapiritsi atsopano a kuthamanga kwa magazi (lisinopril, losartan, hydrochlorothiazide) kapena mankhwala opha maantibayotiki (metronidazole, tetracycline), funsani makamaka ngati lithiamu yanu iyenera kuchepetsedwa komanso pamene mlingo wanu wotsatira wa magazi uyenera kuchepetsedwa kwa ola la 12.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndingadziwe bwanji kusiyana pakati pa kugwedeza kwamanja kwa lithiamu ndi chivomezi choopsa cha lithiamu?¶

Kunjenjemera kwabwinoko kochokera ku mankhwala a lithiamu ndiko kunjenjemera kwabwino, kofulumira, kosawoneka bwino kwa nsonga za chala mukagwira manja anu patsogolo panu, mofanana ndi kumwa khofi wambiri. Kugwedeza kwamphamvu kwa lithiamu ndi kugwedezeka kwamphamvu, pang'onopang'ono, kwakukulu, kosakhazikika kwa manja ndi manja komwe kumachitika popuma komanso pofika pa zinthu, zomwe zimakupangitsani kutaya zakumwa kapena kutaya ziwiya. Ngati kunjenjemera kokulirakulira kumayendera limodzi ndi kusalankhula bwino, kupunthwa bwino (ataxia), kugwedezeka kwa minofu, nseru, kapena kusokonezeka, ndizovuta zachipatala zomwe zimafuna kuti apite kuchipatala mwachangu.

Chifukwa chiyani kutenga ibuprofen (Advil/Motrin) kapena naproxen (Aleve) kwa masiku angapo kunayambitsa poizoni wa lithiamu?¶

Impso zanu zimadalira mamolekyu achilengedwe ozindikiritsa otchedwa prostaglandins kuti asungitse mitsempha yamagazi (afferent arterioles) ku zosefera zawo zazing'ono zotseguka. Non-steroidal anti-inflammatory drugs (NSAIDs) monga ibuprofen ndi naproxen block prostaglandins, yomwe imachepetsa mitsempha ya magazi a impso, imagwetsa kusefedwa kwa impso, ndikunyengerera machubu a impso kuti abwererenso mpaka 60 peresenti ya lithiamu m'magazi anu m'malo motulutsa mkodzo wanu. Pakangotha ​​​​masiku atatu mpaka 7 mutamwa ibuprofen kapena naproxen, mlingo wa lithiamu wotetezeka wa tsiku ndi tsiku ukhoza kufika ku neurotoxic.

Chifukwa chiyani kumangidwa kwa lithiamu "okhazikika" nthawi zambiri kumakhala kowopsa ku ubongo kuposa kumeza mapiritsi a lithiamu nthawi imodzi?¶

Lithiamu imawoloka chotchinga cha magazi ndi ubongo pang'onopang'ono, kutenga maola 24 mpaka 48 kuchoka m'magazi kupita ku maselo aubongo. Munthu amene satenga lithiamu nthawi zambiri amamwa mowa wambiri nthawi imodzi, magazi awo amakwera kwambiri (nthawi zambiri pamwamba pa 3.0 kapena 4.0 mEq / L) mkati mwa maola angapo, koma ubongo wawo udakali ndi lithiamu yochepa kwambiri mkati mwake, kupatsa madokotala nthawi yochotsa lithiamu ndi dialysis musanayambe kuwonongeka kwa ubongo. Mosiyana ndi zimenezi, munthu amene amatenga lithiamu tsiku ndi tsiku ndipo pang'onopang'ono amamanga poizoni m'masiku angapo akutaya madzi m'thupi ali kale ndi ubongo wodzaza ndi lithiamu, kotero ngakhale magazi a 1.6 mpaka 2.2 mEq / L angayambitse chisokonezo chachikulu, kugwidwa, coma, ndi kuwonongeka kosatha kwa cerebellar ( SILENT).

Chifukwa chiyani makala opangidwa sagwira ntchito kuti lithiamu overdose mu chipinda chadzidzidzi?¶

Makala ogwiritsidwa ntchito amagwira ntchito potsekera mamolekyu akuluakulu, opangidwa ndi kaboni mkati mwa timabowo tating'ono tating'ono. Chifukwa lithiamu ndi chitsulo chaching'ono, chokhala ndi magetsi (chofanana ndi mchere wa sodium kapena potaziyamu), sichimamatira ku makala opangidwa konse. M'malo mwake, ngati wina ameza mapiritsi ambiri a lithiamu otulutsidwa nthawi yayitali, madotolo azadzidzidzi amathamangitsa mapiritsi osayamwa kuchokera m'mimba pogwiritsa ntchito Irrigation ya M'matumbo Onse, ndikulowetsa njira yoyezera ya polyethylene glycol electrolyte mpaka matumbo atha.

Kodi SILENT syndrome pambuyo pa poizoni wa lithiamu ndi chiyani?¶

SILENT imayimira Syndrome of Irreversible Lithium-Effectuated Neurotoxicity. Ochepa mwa odwala omwe amakhala ndi kawopsedwe ka lifiyamu kwanthawi yayitali, makamaka akavutitsidwa ndi kutentha thupi kwambiri, kutaya madzi m'thupi, kapena kuchedwa kulandira chithandizo, lithiamu imawononga ma cell a minyewa ya Purkinje mu cerebellum (kukhazikika ndi kulumikizana pakati paubongo). Ngakhale lithiamu itachotsedwa kwathunthu m'magazi, odwala omwe ali ndi SILENT akhoza kukhala ndi vuto la nthawi yaitali kapena losatha kuyenda popanda thandizo (cerebellar ataxia), kulankhula momveka bwino, kuyenda kwa maso mosasamala (nystagmus), ndi kunjenjemera kwa manja kwa miyezi kapena zaka.

Maupangiri ogwirizana¶

• Poizoni wa chakudya, pachimake gastroenteritis, ndi kutaya madzi m'thupi thandizo loyamba
• Kulanda thandizo loyamba ndi chitetezo
• Matenda a khunyu, kukomoka kwa nthawi yayitali, ndi mankhwala opulumutsa
• Kuvulala kwakukulu kwa impso, rhabdomyolysis, ndi kuyesedwa kwa mkodzo wakuda
• Thandizo loyamba la poyizoni ndi kuwongolera poyizoni

Magwero ndi malangizo ovomerezeka¶

• EXTRIP (Extracorporeal Treatments in Poisoning) Gulu la Ntchito: Kubwereza Mwadongosolo ndi Malangizo Ogwiritsira Ntchito Zachipatala kwa Extracorporeal Treatment (Hemodialysis) mu Lithium Poisoning (Clinical Journal of the American Society of Nephrology).
• American Association of Poison Control Centers (AAPCC) & American College of Medical Toxicology (ACMT): Malangizo a Management of Acute, Acute-on-Chronic, and Chronic Lithium Toxicity.
• National Poisons Information Service (NPIS, United Kingdom) & National Institute for Health and Care Excellence (NICE): TOXBASE Lithium Toxicity Management and Safe Lithium Monitoring Guidelines.
• World Health Organisation (WHO): Clinical Management of Acute and Chronic Psychotropic Medication Poisoning.
• Malangizo Ochizira (Australia): Toxicology and Wilderness: Lithium Poisoning, Irrigation yamatumbo Onse, ndi Nephrogenic Diabetes Insipidus Protocols.

*Bukhuli ndi lofuna kudziwa zambiri ndipo sililowa m'malo mwa kuwunika kwachipatala, kukaonana ndi Poison Control, kapena chithandizo chadzidzidzi chachipatala. Chifukwa chakupha kwambiri kwa lithiamu kungayambitse kutayika kwadzidzidzi, kusokonezeka, ndi kugwidwa kwadzidzidzi, timalimbikitsa kwambiri kutenga chithandizo choyamba chovomerezeka ndi CPR kudzera ku International Federation of Red Cross ndi Red Crescent Societies (IFRC), gulu lanu la Red Cross, St John Ambulance, kapena wothandizira wovomerezeka wamba.