Lithium Toxicity: Coarse Tremor, Confusion, Dehydration, uye NSAID Interaction Triage.¶

Lithium (inotsanangurwa se lithium carbonate kana lithium citrate pasi pemazita emhando akadai seEskalith, Lithobid, Priadel, uye Camcolit) ndiyo yegoridhe-standard mood stabilizer yebipolar disorder uye kurapwa-resistant depression. Nekudaro, lithium imonovalent cation (Li+) ine hwindo rakatetepa rekurapa (0.6 to 1.2 mEq/L kana mmol/L) uye zero hepatic metabolism: 100 muzana ye lithium inotorwa inocheneswa kuburikidza neitsvo pamwe chete nesodium nemvura. Nekuti itsvo yemunhu inobata lithium zvakafanana kune sodium mune proximal renal tubules, chero chinhu chinopedza sodium yemuviri kana mvura, kana kuderedza renal kuyerera kweropa, inonyengera itsvo kuti idzorere zvine hukasha lithium kudzoka muropa. Kana mumwe munhu anotora lithium akaita kubvunda kweruoko, kutaura kusina kugadzikana, kutadza kugadzikana kufamba (ataxia), kuvhiringika, kugwinha-gwinha mhasuru, kana kuramba achirutsa uye kuita manyoka, fonera nhamba yako ye emergency (911 muUnited States neCanada, 112 mhiri kweEuropean Union, 999 muUnited Kingdom) nhamba dze emergency dhairekitori ipapo, uye ongorora chepfu rubatsiro rwekutanga, kubata rubatsiro rwekutanga,uye chepfu yezvokudya uye kupera mvura mumuviri.

Chii chinoita kuti lithium poisoning ive nenjodzi ndeyekuti isingaperi kana kuti acute-on-chronic toxicity (apo murwere anotora tsamba yake yemazuva ese anoshaya mvura kubva mukudikitira muchirimo, utachiona hwemudumbu, chikafu chine munyu wakaderera, kana kutanga imwe over-the-counter NSAID senge ibuprofen/naproxen,ACE inhibitor inokonzeresa kukuvara kwakanyanyaazide muuropi mazinga eropa* pane imwe-nguva acute pill overdose ari lithium-naive munhu. Mune chepfu isingaperi, lithium yakatozadza intracellular brain tissue, zvichiita kuti pave nekuvhiringidzika, kubatwa, coma, uye kukuvara kusingagadziriswi kwecerebellar brain kunozivikanwa se ** SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity) ** kana isingazivikanwe uye yakacheneswa nokukurumidza ne intravenous normal saline hydration*.

Ita izvi ikozvino¶

1. ** Dana rubatsiro rwezvehutano hwekukurumidzira uye kutonga kwechepfu nekukasira **: Fonera 911 (US neCanada), 112 (EU), kana 999 (UK) nekukurumidza kana munhu anotora lithium akatanga kubvunda kwakakasharara, kutaura kusinganzwisisike, kugumburwa kana kutadza kufamba akatwasuka, hope, kuvhiringidzika, kuzunungusa tsandanyama, kana kubatwa nepfari, kana munhu akamedza lithiamu. MuUnited States, fonerawo Poison Control pa1-800-222-1222.
2. **Bata mamwe madosi e lithium uye rega kupindirana nemishonga nekukasira **: Usape imwe dose ye lithium. Kurumidza kumisa chero pamusoro pe-the-counter ** NSAID zvinoderedza marwadzo ** (ibuprofen [Advil, Motrin], naproxen [Aleve], celecoxib, meloxicam, diclofenac), ** diuretics ** (hydrochlorothiazide, chlorthalidone, furosemide), kana ** ACE inhibitors, * (lisiprispris, ARB, ARB, ARB, ARB, L. valsartan), uye unganidza bhodhoro rese repiritsi kuti upe kuna chiremba wekukurumidzira.
3. **Cherechedza nguva chaiyo yewachi yekupedzisira lithium dose uye kuumbwa **: Tarisa bhodhoro kuti uone kana mahwendefa ari ** pakarepo-kusunungurwa ** kana ** kusunungurwa-kusunungurwa / kuwedzerwa-kusunungurwa ** (zvakadai seLithobid, Eskalith CR, kana Priadel). Nekuti yakaramba ichiburitswa lithium inotora zvishoma nezvishoma pamusoro pe6 kusvika 12+ maawa uye inogona kukwira mudumbu concretions, vanachiremba vanoda chaiyo yekumedza nguva yekuraira serial mazinga eropa maawa maviri kusvika mana.
4. Usape mvura yakachena isina munyu yakawanda kana kurutsa : Usambomanikidza kugumha gumha kana kurutsa. Kana munhu wacho akasvinura, akasvinura, uye achikwanisa kumedza pasina kurutsa achimirira kurapwa, sips yeoral rehydration solution kana salted broth haina ngozi kudarika mvura isina mvura, nekuti lithium toxicity inowanzokonzera nephrogenic diabetes insipidus (massive dilute urination) uye sodium depletion inogamuchira kununurwa 9%* muchipatara neSalineravenous.
5. ** Chengetedza munhu kubva pakudonha uye gadzirira kubatwa kamwe kamwe **: Nokuti lithiamu inonyatso tarisa cerebellum uye motor cortex, varwere vanokura zvakanyanya **ataxia (kurasikirwa kwechiyero) ** uye kamwe kamwe ** myoclonic jerks ** inofambira mberi nokukurumidza mu generalized tonic-clonic seizures. Tungamira munhu kuti arare pamubhedha wakaderera, mubhedha, kana pasi kure nefenicha yakaoma. Kana kubatwa nepfari kukatanga, vakungurudze parutivi rwavo munzvimbo yekupora uye usamboisa chero chinhu mumuromo mavo.
6. ** Nyeverai vashandi vekuchipatara kuti vasape marasha akabatidzwa e lithium chete **: Kusiyana nemimwe mishonga yese, ** lithium ioni yesimbi inochajwa.Li+) iyo haisungiri kumarasha akabatidzwa **. Nokuda kwekusimudzira-kusunungurwa kwe lithium overdoses, madhipatimendi ekukurumidzira anoshandisa **Whole-Bowel Irrigation (WBI) ** ne polyethylene glycol electrolyte solution panzvimbo.

Muti wesarudzo: Acute, acute-on-chronic, uye isingaperi lithium toxicity triage¶

flowchart TD
    Start["Inofungidzirwa Lithium Toxicity (Mushandisi Wezuva Nezuva Ane Zviratidzo Zvitsva KANA Acute Pill Overdose)"] --> CallEMS["Dana 911/112/999 uye Kudzora Chepfu; Bata Lithium, NSAIDs, Diuretics, uye ACEi/ARBs"]
    CallEMS --> Classify["Classify Pateni: Acute (Naive) vs Acute-on-Chronic vs Chronic Accumulation"]

    Classify -->|Acute or Acute-on-Chronic Ingestion| GI_Rule["Chipatara GI Decontamination: Usashandise Activated Charcoal (Haisi Kusunga Lithium); Shandisa Yese-Bowel Irrigation (PEG-ELS) yeSustained-Release > 20-30 Tablets"]
    Classify -->|Chronic Toxicity (Triggered by Dehydration / AKI / NSAIDs / Thiazides)| NeuroCheck["Ongorora Neurological Severity (Yakanaka -> Coarse Tremor, Ataxia, Dysarthria, Myoclonus, Delirium, Seizures)"]
    GI_Rule --> NeuroCheck

    NeuroCheck --> StartIV["Pakarepo Hospital Resuscitation: Intravenous 0.9% Normal Saline (Dzorera GFR uye Proximal Tubular Sodium Delivery) + Monitor yeNephrogenic Diabetes Insipidus (Hypernatremia)"]
    StartIV --> SerialLabs["Dhirosa STAT Serum Lithium (muNON-Lithium-Heparin Tube), Renal Panel (Creatinine / BUN), Serum Sodium, uye 12-Lead ECG; Dzokorora Lithium Level yega yega 2-4 Maawa"]

    SerialLabs --> EXTRIP_Check{"Tarisa EXTRIP Criteria yeEmergency Intermittent Hemodialysis"}

    EXTRIP_Check -->|1. ANY Severe Neurological Symptoms (Seizures, Coma, Delirium, Severe Ataxia) Regardless of Lithium Level| Dialysis["TANGA EMERGENCY INTERMITTENT HEMODIALYSIS IYE ZVINO"]
    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["Ramba IV Normal Saline Hydration + Serial Lithium Levels Kusvikira <1.0 mEq/L uye Neurologically Baseline"]

    Dialysis --> ReboundCheck["Monitor Serum Lithium 6-12 Maawa Mushure meDialysis yeRebound Elevation (Sezvo Lithium Inogoverazve Kunze Kwehuropi / Intracellular Tissue MuRopa); Dzokorora Dialysis kana Zvichidiwa"]

Pathophysiology: Sei Idzo Inokanganisa Lithium neSodium¶

Kuti unzwisise kuti sei zviitiko zvezuva nezuva, zvakadai sekupera kwevhiki rinopisa, 24-awa dumbu rebug, yakaderera-sodium uremu-kurasikirwa kudya, kana kutenga bhodhoro reAdvil nokuda kwechidzitiro chakaputika, zvinogona kutumira murwere we lithium akagadzikana muimba yekuchengetedzwa kwakanyanya mukati maawa 72, unofanira kunzwisisa ** proximal tubular sodium-lithium kubata **:

1. The Proximal Tubule Sodium-Substitution Trap¶

Lithium (Li+) inogara zvakananga pamusoro pesodium (Na+) muBoka 1 (iyo alkali simbi) yetafura ye periodic. Nekuti lithium haina metabolized nechiropa uye haisungiri kumapuroteni eropa (0% protein binding), 100 muzana yelithium iri muropa inosefa zvakasununguka paitsvo glomerulus ichipinda mutsvo.

Pasi pezvakajairwa, zvakanaka-hydrated mamiriro: - ** 70 kubva muzana kusvika ku80 muzana yelithium yakasvibiswa inodzorerwa zvakare muropa muProximal Convoluted Tubule (PCT) ** pamwe chete nesodium nemvura, zvichisiya chete 20 muzana kusvika 30 muzana kuti ibudiswe mumuguta. - Pese apo muviri unonzwa ** kuderera kwesodium, kupera mvura mumuviri, kana kuderedzwa renal perfusion ** (kubva kudikitira, kurutsa, manyoka, fivha, kutadza kwemoyo, kana cirrhosis), itsvo dzinoita iyo ** renin-angiotensin-aldosterone system (RAAS) ** kununura nekukurumidza ion yega yega yesodium uye donho remvura muproximal tubule. - Nekuti proximal tubular vatakuri (NHE3 uye paracellular nzira) ** haigone kusiyanisa pakati pe sodium (Na+uye lithium (Li+)**, iyo sodium-nzara itsvo inodzoreredza ** ingangoita 90 muzana kusvika 99 muzana yeyakasefetwa lithium ** pamwe chete nesodium. Lithium excretion inodonha kusvika pedyo ne zero, uye murwere wemazuva ese lithium dose inokurumidza kudonha muropa rine chepfu uye kudzika kwehuropi.

2. Iyo "Triple Whammy" Kudyidzana Kwezvinodhaka Kunovhara Lithium Clearance¶

Makirasi matatu emishonga yakajairwa anokonzeresa yakasimba isingaperi lithium toxicity nekurova glomerular filtration kana kumanikidza proximal tubular lithium reabsorption:

3. The Nephrogenic Diabetes Insipidus Vicious Cycle¶

Chronic lithium therapy pachayo inokuvadza kugona kweitsvo kutarisisa weti: - Lithium inopinda mumasero makuru e ** renal kuunganidza duct ** kuburikidza ne ** epithelial sodium migero (ENaC) ** uye inhibits intracellular ** glycogen synthase kinase-3 beta ** uye ** adenylyl cyclase **. - Izvi zvinoita kuti kuunganidza duct kusava nehanya ne **Antidiuretic Hormone (ADH / Vasopressin) **, kuderedza ** Aquaporin-2 migero yemvura ** uye kukonzera ** Yakawanikwa Nephrogenic Diabetes Insipidus (NDI) ** kusvika ku20 muzana kusvika ku40 muzana yevashandisi venguva refu ye lithium. - Varwere vane lithium-induced NDI inobvisa mavhoriyamu makuru (3 kusvika 8+ marita pazuva) ye dilute, weti ine mvura (polyuria) uye vanofanira kunwa nguva dzose (polydipsia) kuti varambe vaine hydrated. Kana murwere iyeye akabata tsikidzi yemudumbu, akavhiringika zvinyoro, akarara muchipatara, kana kuti haakwanise kuwana zvinwiwa chero ** 12 kusvika kumaawa 24 **, anorasikirwa marita emvura yemahara kuburikidza neweti yavo, achikura nekukurumidza ** kupera kwakanyanya, hypernatremia (high blood sodium), acute itsvo kukuvara, uye fulminant lithium neurotoxicity **.

Iwo Matatu Matatu eLithium Poisoning uye Clinical Severity Grading¶

1. Kuenzanisa Acute, Acute-on-Chronic, uye Chronic Lithium Toxicity¶

2. Neurological Progression: Kubva Fine Action Kubvunda kuenda kuCoarse Tremor uye KUNYARARA¶

Iwe unoudza sei mutsauko pakati pekusakuvadza mhedzisiro yeyakajairika zuva nezuva lithium uye yechokwadi yekurapa emergency chepfu?

1. Benign Therapeutic Side Effect (Yakajairwa Lithium Level 0.6 to 1.2 mEq/L):
2. ** Yakanaka postural / chiito kudedera **: Kutsanya (8 to 12 Hz), zvisingaonekwi, kubvunda kwakafanana kweminwe yakatambanudzwa (yakafanana nekudengenyeka kwecaffeine) iyo isingadzivisi kubata kapu kana kunyora, pamwe chete nekutaura kwakajairika, kuenzanisa kwekufamba, uye kufunga kwakajeka.
3. Zvinyoro-ku-Moderate Lithium Toxicity (Kazhinji 1.5 to 2.5 mEq/L in Chronic Toxicity):
4. Kubvunda kwemaoko kwakakasharara, zvisina tsarukano uye kubvunda kwemakumbo: Kudengenyeka kwechigunwe kunononoka uye kunobva kwaita inooneka yakafara, jee, kubvunda kwakakasharara kunokanganisa kuzorora uye kufamba kune chinangwa, kudurura mvura kubva mugirazi, kudonhedza sirivheri, kana kuita kuti runyoro rusanyoreke.
5. ** Cerebellar Ataxia uye Dysarthria **: Nokuti lithium inosarudza chepfu masero ePurkinje mu ** cerebellum **, munhu anotanga kufamba nehupamhi-based, kuzununguka, kudhakwa gait (**ataxia **), slurring mazwi avo (**dysarthria ), uye kuratidza involuntary jesarth rhythm r.
6. ** Neuromuscular Hyperexcitability : Kushaya simba kwetsandanyama, hyperactive deep tendon reflexes ( hyperreflexia ), tsandanyama fasciculations (rippling twitches pasi peganda), uye kamwe-kamwe kusagadzikana-kufanana nemisungo jerks ( myoclonus **).
7. Early Encephalopathy: Husimbe, kusakendenga, kusagadzikana, kuvhiringidzika, kana kuomerwa nekuwana mazwi.
8. ** Yakanyanya Lithium Toxicity (Kazhinji > 2.5 mEq/L Chisingaperi, kana Chero Chinhanho chine Encephalopathy)**:
9. Choreoathetosis uye Parkinsonian/Extrapyramidal Rigidity: Kuomarara kwetsandanyama yeCogwheel, kufamba kwemakumbo nemakumbo, uye kusakwanisa kumira kana kugara.
10. Delirium, Stupor, uye Coma: Kuvhiringika kukuru kunofambira mberi kusvika pakusapindura.
11. Generalized Tonic-Clonic Seizures uye Non-Convulsive Status Epilepticus: Lithium inodzikisira chikumbaridzo chekubatwa nepakati pecerebral cortex.
12. Cardiac Conduction Changes: While cardiac arrest is less common than brain injury, lithium substitutes for intracellular potassium in the heart muscle, producing flattened or inverted T waves (mimicking hypokalemia), sinus node dysfunction / sick sinus syndrome (severe bradycardia or sinoatrial block), QTc prolongation, and occasionally Brugada-like ECG patterns.
13. Iyo Yekusingaperi Kukuvadzwa Kwehuropi Kutyisidzira: KUNYARARA (Syndrome yeIrreversible Lithium-Effectuated Neurotoxicity):
14. Muchikamu che10 muzana chevarwere vanotambura zvakanyanya kwenguva refu chisingaperi lithium toxicity, kunyanya kana ichiperekedzwa ne ** high fever (hyperthermia) **, kupera simba, kana kushandiswa kwepanguva imwe chete antipsychotic, lithium inokonzera ** demyelination zvachose uye kuparadzwa kwakapararira kwecerebellar Purkinje masero **.
15. Kunyange mushure mokunge lithiamu yose yabviswa kubva mumuviri, vanobatwa ne ** SILENT ** vanosara ne ** zvachose, yeupenyu hwose cerebellar ataxia (kusakwanisa kufamba pasina mufambi kana wiricheya), kuongorora kutaura kusina kunaka, kunoramba kuine kudengenyeka kwakaoma, nystagmus, kana cognitive dementia ** mwedzi inogara kusvika kumakumi emakore. Kukurumidza kuzivikanwa, kudzora kupisa, uye kutanga hemodialysis ndiyo nzira chete dzekudzivirira KUNYARARA.

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

1. Ropa Tube Musungo: Usambodhirowa Lithium Level muGreen-Pamusoro Lithium-Heparin Tube¶

2. Kusvibiswa kweGastrointestinal Decontamination: Sei Marasha Akabatidzwa Achitadza uye Nguva Yekushandisa Kudiridza Ura Hwose¶

• Usape Mamarasha Akabatidzwa Nemumiriri Mumwechete Lithium Overdose: Marasha akabatidzwa anoshambadza mamorekuru emishonga kabhoni kuburikidza nemauto asiripolar van der Waals. Nekuti lithium idiki, inochajirwa inorganic simbi ion (Li+), activated charcoal ine zero binding capacity for lithium (inopihwa chete kana murwere akabatana nemumwe mushonga weorganic senge antidepressant kana antipsychotic).
• Sodium Polystyrene Sulfonate (Kayexalate) HAIYE Inokurudzirwa: Kunyange zvakadzidzwa kare kuti ichinje sodium yelithium muura, vanachiremba vezvetoxicologist vanopa zano pamusoro pemaitiro eKayexalate nekuti inoda madosi makuru anokonzera yakanyanya hypokalemia, hypernatremia, uye bowel necrosis.
• Whole-Bowel Irrigation (WBI) yeSustained-Release Lithium: Nekuti anoramba achiburitsa lithium carbonate mapiritsi (akadai se Lithobid kana Priadel) anonwa zvishoma nezvishoma kwemaawa gumi nemaviri kusvika makumi maviri nemana+ uye anogona kubatana mudumbu remukati (*pharmacoberi) kwemazuva ekuti lithium ichienderera mberi. Kudiridza ** ne ** polyethylene glycol electrolyte solution (PEG-ELS pa 1.5 kusvika 2 L/awa kuburikidza ne nasogastric tube) ** inokurudzirwa kune vakasvinura, varwere vanodzivirirwa nemhepo vanouya mushure mekudya kukuru (kazhinji ** kupfuura 20 kusvika ku30 mapiritsi kana > 50 kusvika 80 kusvika 80 mg-kg) yelithiyase * yetimumu *
• **Serial Lithium Levels Ese 2 kusvika 4 Maawa : Usambofa wakavimba nekamwe yekubvuma lithium level mushure meacute kana acute-on-chronic kumedzwa. Nekuda kwekuti kunyura-kuburitswa kunononoka, serum lithium mazinga anofanirwa kutariswazve ** maawa maviri kusvika mana ega ega kusvika mwero wanyatsokwira uye uchidzika kudzika kune yakajairika.

3. Intravenous Fluid Resuscitation (0.9% Normal Saline, NOT Forced Loop Diuresis)¶

Iro ibwe repakona rekurapa kune wese murwere ane lithium toxicity ** kudzorera intravascular volume, glomerular filtration rate (GFR), uye proximal tubular sodium delivery : - Tanga Intravenous 0.9% Yakajairika Saline (0.9% NaCl) Pakarepo : Gadzira bolus yekutanga ye ** 1,000 kusvika 2,000 mL ye 0.9% Normal Saline ** kana murwere ari vhoriyamu-yakapera kana hypotensive, inoteverwa nekuenderera kwekuchengetedza infusion pa ** 1.5 kusvika 2 nguva yakajairika yekuchengetedza chiyero (kazhinji 150 kusvika 200 kusvika 200 mL * 1 nguva, 500 kusvika ku200 mL * 1 awa, kuburitsa uri mukati meawa. 3 mL/kg/awa. - Maitirwo eSaline Yakajairika Inovhura Renal Lithium Clearance: Kuunza yakawandisa sodium (Na+) uye mvura kuitsvo inodzima renin-angiotensin-aldosterone system uye inofashamira iyo ** proximal convoluted tubule ** ine sodium ions, ichimisa itsvo kuti isatorazve lithium uye ichibvumira lithium kubuda muweti. - ** Tarisa uone Hypernatremia kubva kuNephrogenic Diabetes Insipidus: Tarisa serum sodium (Na+) maawa mana oga oga. Kana murwere ane underly ** lithium-induced nephrogenic diabetes insipidus (excreting litres of dilute, weti isina munyu), achipinza 0.9% Normal Saline chete pasina kutsiva mvura yakasununguka inogona kukurumidza kutyaira serum sodium pamusoro 150 kusvika 160 mEq/L (yakanyanya hypernatremia neurological deliological), Mune varwere vane NDI uye inokwira serum sodium, vanachiremba vanochinja kune kana kusanganisa ** hypotonic fluids (0.45% Half-Normal Saline kana D5W) ** uye inogona kupa amiloride ** (a potassium-sparing diuretic iyo inonyanya kuvhara epithelial sodium channels [ENaC] mumugero wekuunganidza, kudzivirira lithium kupinda mumasero makuru uye kuvandudza NDI). - ** Usambofa Uchishandisa Loop Diuretics (Furosemide) kana Thiazides ku "Force Diuresis": Kupa furosemide (Lasix), bumetanide, kana mannitol "kumanikidzira kubuda weti" chaizvoizvo ** inopedza sodium uye inoderedza lithium clearance **, kuwedzera lithium toxicity.

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

Nekuti lithium ine huremu hudiki hukuru (7 Daltons), ** zero protein inosunga (0%)**, uye vhoriyamu diki yekugovera (0.7 to 0.9 L/kg), lithium ndomumwe wemuchetura unodhaya zvakanyanya mumishonga yese.

• **Intermittent Hemodialysis (IHD) vs. CRRT **: High-efficiency Intermittent Hemodialysis (IHD) inobvisa lithiamu kakapetwa kane nekukurumidza kupfuura Continuous Renal Replacement Therapy (CRRT / CVVHDF) uye nguva dzose ndiyo inosarudzwa nzira yekutanga kubviswa nokukurumidza.
• EXTRIP Consensus Zviratidzo zveEmergency Hemodialysis muLithium Poisoning:
• Zvakaoma Neurological Symptoms pane CHESE Lithium Level: Coma, pfari, dysrhythmias inotyisidzira upenyu, kana yakanyanya delirium/encephalopathy/ataxia, zvisinei nekuti serum lithium level i1.8 mEq/L kana 5.0 mEq/L.
• Serum Lithium> 4.0 mEq/L mune chero murwere ane **inokanganisa itsvo basa ** (acute itsvo kukuvara kana chirwere cheitsvo chisingaperi).
• Serum Lithium > 5.0 mEq/L mu **murwere chero upi zvake **, kunyangwe ivo parizvino vaine itsvo dzakajairwa uye zero zviratidzo (sekutanga mushure mekudya zvakanyanya).
• **Kurebesa Clearance Projection **: Kana kuvhiringidzika kuripo, KANA kana nguva inotarisirwa inodiwa kuderedza serum lithium concentration pazasi 1.0 mEq/L ine optimal IV hydration inopfuura **36 maawa **.
• ** Iyo Post-Dialysis "Rebound" Phenomenon **:
• Hemodialysis inokurumidza kubvisa lithium kubva mu **bloodstream **, ichidonha serum lithium level pazasi. 1.0 mEq/L pakupera kwe6-awa dialysis session.
• Zvisinei, nokuti lithium inofamba kubva ** intracellular compartments (brain and muscle) ** zvishoma nezvishoma, ** 6 kusvika maawa 12 mushure mokumisa dialysis machine **, lithium inopararira kunze kwematishu ichidzokera muropa (uye chero mapiritsi akasara-anosunungurwa mumatumbo anoramba achitora), zvichiita ** post-dialysis rebound spike * * mu serum lithium mazinga.
• Nokudaro, vanachiremba vanogara vachiongorora serum lithium ** 6 kusvika maawa 12 mushure me hemodialysis ** uye vanowanzoita ** inodzokororwa intermittent hemodialysis sessions ** (kana kuchinja kune ** CRRT ** mushure mekutanga IHD chikamu) kusvikira mushure mekugadzirisa zvakare lithium level inoramba yakadzikama pasi pe ** 1.0 mEq / L ** uye murwere ari kuvandudza kliniki. (Cherechedza: Kunyangwe uwandu hweropa hwachinja, kupora kwetsinga kazhinji kunononoka nemazuva akati wandei nekuti uropi hunoenderana zvishoma).

Chengetedzo Yekudzivirira yeVarwere Vanotora Zuva Nezuva Lithium¶

• ** Usambofa watora ibuprofen (Advil, Motrin) kana naproxen (Aleve) **: Chengeta ** acetaminophen (paracetamol / Tylenol) ** kumba nekuda kwemusoro, fivha, kana mhasuru aches (chero usina chirwere chechiropa), sezvo acetaminophen isingavharidzi renal lithium clearance.
• Tevedzera "Mitemo Yezuva Rokurwara": Kana ukatanga kurutsa, manyoka, kupisa muviri kwakanyanya, kana kunyorovesa dikita kubva mukupisa kwechirimo kana kuita maekisesaizi, **chimbomira kutora piritsi rako relithium kwechinguva **, inwa mvura ine electrolyte, uye fonera chiremba wako kana kiriniki zuva rimwe chetero kuti uongorore ropa relithium neitsvo.
• ** Chengetedza kudya kwako kwezuva nezuva kwemunyu (sodium) kwakagadzikana **: Usambofa watanga kuparara kamwe kamwe-yakaderera-sodium kudya kana kutsanya kuchenesa pasina chiremba wako kugadzirisa yako lithium dose kutanga, nokuti kamwe-kamwe madonhwe mumunyu wekudya pakarepo anoita kuti itsvo dzako dzichengete lithium.
• Yeuchidza chiremba wese, chiremba wemazino, uye wezvemishonga kuti unotora lithium: Usati watanga chero piritsi idzva reBP (lisinopril, losartan, hydrochlorothiazide) kana mushonga unorwisa mabhakitiriya (metronidazole, tetracycline), bvunza zvakananga kana lithium yako inoda kuderedzwa uye apo yako inotevera 12-awa yeropa inofanira kutorwa.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Mibvunzo inowanzo bvunzwa¶

Ndingaziva sei mutsauko uripo pakati peyakajairwa lithium ruoko kudengenyeka uye ine ngozi ine muchetura lithium kudedera?¶

Kudedera kwakajairwa kudivi rekurapa kubva pakurapwa lithium kudedera kwakanaka, nekukurumidza, kusinga nyatso kuoneka kweminwe paunobata maoko ako pamberi pako, zvakafanana nekunwa kofi yakawandisa. Muchetura welithium kudedera kugwinha, kunonoka, kwakafara, kusingaenzaniswi kwemaoko nemaoko kunoitika pakuzorora uye pakusvika kune zvinhu, zvichiita kuti utese zvinwiwa kana kudonhedza midziyo. Kana kudengenyeka kunowedzera kunoperekedzwa nekutaura kusina kujeka, kugumburwa kwekuenzanisa (ataxia), kuzununguka kwetsandanyama, kusvotwa, kana kuvhiringidzika, injodzi yekurapa inoda kuongororwa kuchipatara nekukurumidza.

Sei kutora pamusoro-the-counter ibuprofen (Advil/Motrin) kana naproxen (Aleve) kwemazuva mashomanana yakakonzera yakanyanya lithium poisoning?¶

Itsvo dzako dzinovimba nemamolekemu anosaina anonzi prostaglandin kuchengetedza tsinga dzeropa (afferent arterioles) kune mafirita avo madiki akavhurika. Non-steroidal anti-inflammatory drugs (NSAIDs) senge ibuprofen uye naproxen block prostaglandins, iyo inoderedza mitsipa yeropa yeitsvo, inoderedza filtration rate yeitsvo, uye inonyengedza matubhu eitsvo kuti adzore zvakare kusvika 60 muzana yakawanda lithium kudzoka muropa rako pane kuibudisa muweti yako. Mukati memazuva matatu kusvika manomwe chete ekutora ibuprofen kana naproxen, yaimbove yakachengeteka zuva nezuva dosi ye lithium inogona kuvaka kusvika kune neurotoxic mazinga.

Sei zvishoma nezvishoma "zvisingaperi" lithium kuvaka-up kazhinji ine ngozi kuuropi pane kumedza mashoma emapiritsi e lithium kamwechete?¶

Lithium inoyambuka chipinganidzo cheropa-uropi zvishoma nezvishoma, ichitora maawa makumi maviri nemana kusvika makumi mana nemasere kubva muropa ichienda kumasero europi. Kana munhu asingawanzo kutora lithium akamedza kuwandisa kukuru kamwechete, ropa ravo rinokwira zvakanyanya (kazhinji riri pamusoro pe3.0 kana 4.0 mEq/L) mukati memaawa mashoma, asi uropi hwavo huchiri hune lithiamu shoma mukati mayo, zvichipa vanachiremba nguva yekubvisa lithium ne dialysis isati yaparara uropi. Kusiyana neizvi, mumwe munhu anotora lithium zuva rega rega uye zvishoma nezvishoma anovaka mazinga ane chepfu pamusoro pemazuva akati wandei ekupera mvura ane huropi hwakazadzwa ne lithium, saka kunyangwe mwero weropa we1.6 kusvika 2.2 mEq/L unogona kukonzeresa kuvhiringika kwakanyanya, pfari, coma, uye kukuvara zvachose kwecerebellar (SILENT).

Sei isingashandisi marasha kushanda kune lithium overdose muimba yekukurumidzira?¶

Akabatidzwa marasha anoshanda nekuteya mamorekuru, kabhoni-based organic drug molecules mukati mayo ma microscopic pores. Nekuti lithium idiki, ine magetsi inochajiswa simbi ion (yakafanana nesodium kana potassium munyu), haina kunamatira kune activated charcoal zvachose. Pane kudaro, kana mumwe munhu akamedza nhamba yakawanda yemapiritsi e-lithium akawedzerwa, vanachiremba vanokurumidza kubvisa mapiritsi asina kuvharwa kunze kwechikamu chekudya vachishandisa Whole-Bowel Irrigation, vachiisa chiyero chepolyethylene glycol electrolyte solution kusvikira mudumbu wanyatsocheneswa.

Chii chinonzi SILENT syndrome mushure me lithium chepfu?¶

SILENT inomirira Syndrome of Irreversible Lithium-Effectuated Neurotoxicity. Muchikamu chidiki chevarwere vanotambura zvakanyanya, kwenguva refu isingaperi lithium toxicity, kunyanya kana yakaomeswa nefivha yakanyanya, kupera simba kwemvura, kana kunonoka kurapwa, lithium inoparadza Purkinje tsinga masero mucerebellum (chiyero uye coordination centre yeuropi). Kunyange mushure mokunge lithiamu yakanyatsocheneswa kubva muropa, varwere vane SILENT vanogona kuva nekuoma kwenguva refu kana kusingaperi kufamba pasina rubatsiro (cerebellar ataxia), kutaura kwakashata, kufamba kwemaziso kusinganzwisisiki (nystagmus), uye kudengenyeka kwemaoko kunogara kwemwedzi kana makore.

Mazano anoenderana¶

• Chikafu chepfu, acute gastroenteritis, uye kupera mvura mumuviri rubatsiro rwekutanga
• Kutora rubatsiro rwekutanga uye kuchengeteka
• Status epilepticus, pfari kwenguva refu, uye mishonga yekununura
• Acute itsvo kukuvara, rhabdomyolysis, uye yakasviba weti triage
• Chepfu yekutanga rubatsiro uye chepfu yekudzora triage

Nzvimbo uye nhungamiro yepamutemo¶

• EXTRIP (Extracorporeal Treatments in Poisoning) Boka rekushanda: Systematic Ongororo uye Clinical Practice Recommendations for Extracorporeal Treatment (Hemodialysis) muLithium Poisoning (Clinical Journal yeAmerican Society of Nephrology).
• American Association of Poison Control Centers (AAPCC) & American College of Medical Toxicology (ACMT): Nhungamiro Yekutarisira Acute, Acute-on-Chronic, uye Chronic Lithium Toxicity.
• National Poisons Information Service (NPIS, United Kingdom) & National Institute for Health and Care Excellence (NICE): TOXBASE Lithium Toxicity Management uye Safe Lithium Monitoring Guidelines.
• World Health Organisation (WHO): Clinical Management yeAcute uye Chronic Psychotropic Medication Poisoning.
• Therapeutic Guidelines (Australia): Toxicology and Wilderness: Lithium Poisoning, Whole-Bowel Irrigation, uye Nephrogenic Diabetes Insipidus Protocols.

*Gwaro iri nderezvinangwa zveruzivo uye haritsivi kuongororwa kwehunyanzvi hwekurapa, kubvunza Poison Control, kana rubatsiro rwechimbichimbi muchipatara. Nekuti yakanyanya lithium toxicity inogona kukonzera kurasikirwa kamwe kamwe, kuvhiringidzika, uye kubatwa kwese, isu tinokurudzira zvakasimba kutora yakatenderwa maoko-parubatsiro rwekutanga uye CPR kosi kuburikidza neInternational Federation yeRed Cross neRed Crescent Societies (IFRC), yako yenyika yeRed Cross nzanga, St John Ambulance, kana ane certified yemuno mupi.