Acceso usuarios
María Tajes Alonso, M. Martínez Formoso, Mario Páramo Fernández
Although the acute complications of lithium toxicity involving the central nervous system have been known for more than 70 years, it is only recently that the longlasting sequelae of lithium intoxication have come to be discussed at length. The acronym SILENT (Syndrome of Irrever sible Lithium-Effectuated Neurotoxicity) has been coined recently to denote these sequelae. The peculiar pharmacokinetic characteristics of lithium, as its tendency to accumulate in many tissues with an absolute absence of linkage to plasmatic proteins, could explain the poor correlation between plasmatic lithium levels and the severity of neurological sequelae after an intoxication. Following the study and depiction of a patient admitted at a psychiatric unit at Hospital de Conxo in Santiago de Compostela (Spain), our aim is to analyze the physiopa thological mechanisms of longlasting sequelae after lithium poisoning. We present the case of a middle-aged man who developed a severe demential syndrome with ataxia, dysarthria, global dysphasia and central respiratory alterations following a lithium intoxication. The lithium serum levels reached 4mEq/L but he was only treated with forced diuresis. We report several circumstances that can increase the risk of acute toxicity, including a rapid decrease in serum levels; individual risk factors as a previous renal impairment, concomitant treatment with hidroclorotiazides and an age over fifty; and, finally, an inappropriate treatment of the condition, haemodialysis being the desirable one in a case of acute lithium poisoning in a patient chronically treated with the drug.
