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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Lithium Toxicity Secondary to Lithium-Losartan Interaction
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Lithium Toxicity Secondary to Lithium-Losartan Interaction

机译：锂与洛沙坦相互作用继发的锂毒性

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Objective: To report a case of lithium toxicity following lithium and losartan coadministration in a diabetic patient.Case Summary: A 61-year-old white male with a history significant for bipolar disorder, hypertension, and diabetes was admitted to the Veterans Affairs Medical Center-based Nursing Home Care Unit for long-term intravenous antibiotic therapy for osteomyelitis. He developed lithium toxicity at a dose previously tolerated (1,350 mg/day) following administration of losartan 50 mg on the day before and day of evidence of toxicity. The drugs had been used concurrently prior to admission without evidence of toxicity; however, adherence to treatment could not be confirmed and concurrent dehydration may have been a contributing factor. Lithium toxicity was evidenced by irritability, tremors, confusion, and disorientation. Results of laboratory studies were significant for an elevated lithium concentration, hyponatremia, and slight elevations of serum creatinine and blood urea nitrogen. All other laboratory values were within normal limits.Discussion: Losartan, an angiotensin-receptor blocker (ARB), is commonly used for treatment of hypertension and heart failure as well as for renoprotection in diabetic patients. It has been shown to interact with lithium, resulting in lithium intoxication, most likely as a result of natriuresis leading to hyponatremia. Hyponatremia and a decrease in the glomerular filtration rate through the action of both angiotensin-converting enzyme inhibitors and ARBs enhance the renal tubular reabsorption of lithium, thus leading to potentially toxic serum concentrations of lithium. An objective causality assessment revealed that the interaction was probable.Conclusions: The temporal fashion in which the episode occurred indicated that a lithium-losartan interaction was probably the cause of lithium toxicity in this patient. Clinicians need to be aware of potential lithium-ARB interactions resulting in an increased risk of lithium toxicity associated with concurrent use of these drugs.
机译：目的：报告一例糖尿病患者锂和氯沙坦合用后发生锂中毒的病例。病例摘要：一位患有双相情感障碍，高血压和糖尿病的病史的61岁白人男性被送往退伍军人事务医疗中心总部设在疗养院的单位，用于对骨髓炎进行长期静脉抗生素治疗。在毒性证据出现的前一天和一天，在服用洛沙坦50 mg后，他以先前可以耐受的剂量（1350 mg /天）出现了锂中毒。这些药物在入院前已同时使用，没有毒性证据;但是，不能确定是否坚持治疗，同时脱水可能是一个促成因素。锂的毒性表现为烦躁，震颤，神志不清和迷失方向。实验室研究的结果对于锂浓度升高，低钠血症以及血清肌酐和血液尿素氮的轻微升高具有重要意义。讨论：所有其他实验室值均在正常范围内。讨论：氯沙坦，一种血管紧张素受体阻滞剂（ARB），通常用于治疗高血压和心力衰竭以及糖尿病患者的肾脏保护。已显示它与锂相互作用，导致锂中毒，最有可能是由于利钠导致低钠血症。低钠血症和通过血管紧张素转换酶抑制剂和ARB的作用降低的肾小球滤过率会增强肾小管对锂的重吸收，从而导致潜在的毒性血清锂浓度。客观的因果关系评估表明这种相互作用是可能的。结论：发作的时间性方式表明锂-氯沙坦相互作用可能是该患者锂中毒的原因。临床医生需要意识到潜在的锂-ARB相互作用会导致与同时使用这些药物相关的锂中毒风险增加。

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