The use of lithium salts in medicine and symptoms of the poisoning with them

O.M. Arustamian, V.S. Tkachishin, V.E. Kondratiuk

Abstract


Lithium preparations are psychotropic medicines from the group of mood stabilizers. Their major importance is the treatment of affective disorders, primarily manic phases of bipolar disorder, as well as prevention of its exacerbations and therapy of severe and resistant depressions, they also can prevent suicide. Treatment of bipolar disorders with lithium drugs is based on their ability to inhibit selectively kinase-3-glycogen synthase by competition with magnesium ions. Lithium is an alkali metal, therefore in medicine it is used in the form of salts, mainly carbonate, as well as citrate, succinate, orotate, chloride and lithium sulphate. In addition to psychiatry, lithium and its compounds are used in the production of plastics, organic synthesis, glass blowing industry, pharmaceutical chemistry. Lithium poisoning is often of iatrogenic nature in psychiatric practice. Lithium affects the release of serotonin and receptor sensitivity, and modulates the action of norepinephrine. At present, it is believed that the mechanism of lithium action is associated with inositol depletion in the central nervous system. The neurological symptoms of lithium poisoning include: ataxia, impaired vision, memory loss, dizziness, loss of orientation, convulsive seizures, muscle twitching, stupor and coma. The longer the toxic level of lithium in the blood persists, the greater the likelihood of irreversible changes in the central nervous system. Patient with lithium intoxication must be hospitalized. First aid: sodium chloride and potassium chloride solution per os. It is necessary to measure the concentration of lithium in the blood plasma several times a day. To reduce the concentration of lithium rapidly, it is often effective to administer the physiological solution intravenously at a rate of 150–200 ml per hour. First of all, gastric and intestinal lavage should be done (especially with long-acting drug poisoning). Since gastric juice often has a high concentration of lithium, prolonged aspiration of the stomach is indicated. Pathogenetic treatment to be carried out in epileptic seizures, central nervous system depression, arterial hypotension and arrhythmias. The most effective method is hemodialysis. However, it should be noted that objectively positive changes in lithium therapy (if it is successful) far exceed the negative impact of possible side effects.

Keywords


lithium salts; bipolar affective disorders; manic state; depression; lithium salt poisoning; lithium hydroxybuty­rate; psychiatry; acute and chronic intoxications

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DOI: https://doi.org/10.22141/2224-0586.1.88.2018.124966

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