Decreased serum creatine kinase activity in patients receiving parenteral nutrition
✍ Scribed by Amin A. Nanji; Frank H. Anderson
- Publisher
- John Wiley and Sons
- Year
- 1984
- Tongue
- English
- Weight
- 235 KB
- Volume
- 15
- Category
- Article
- ISSN
- 0364-5134
No coin nor oath required. For personal study only.
✦ Synopsis
Apte and Langston [ l ] report two cases suggesting that lithium toxicity can result in permanent neurological sequelae. We examined a patient with similar effects of lithium toxicity. A 38-year-old woman received a provisional diagnosis of manic illness and was placed on lithium, 1,200 mg daily, and thiothixene, 5 mg at bedtime. After one month, the serum lithium level was 0.60 mEqIL.
Three weeks later the patient had maculopapular rash, severe weakness with inability to walk, dysarthria, and diarrhea. She was admitted directly to a dialysis unit. Her condition deteriorated further; she became stuporous, and muscle stretch reflexes were absent. The serum lithium level was 2.06 mEq/L. Blood chemistry values were consistent with acute renal failure and uremia. She had a leukocytosis and eosinophilia. An electroencephalogram showed diffuse slowing. With dialysis treatment her mental status gradually improved, but she retained persistent muscle weakness, dysarthria, and ataxia.
Neurological examination one month after dialysis treatment showed the patient to be alert and oriented but euphoric. She was dysarthric. Memory was intact. She was markedly ataxic, required a walker, and showed decomposition of movement and bilateral intention tremor. Stretch reflexes were brisk throughout and plantar responses were flexor. Sensory examination showed no abnormalities. She was taking no medications. Eleven months after her hospitalization for lithium toxicity the patient was still unable to walk unassisted and had persistent dysarthria.
The findings in this patient resemble those described by Apte and Langston and in other patients reported by Uchigatta and colleagues [ 5 ] , Newman and Saunders C41, Hansen and Amdisen [3], and Goldwater and Pollock C2).
All these authors report a syndrome of dementia, dysarthria, cerebellar ataxia, and tremor. There may be involuntary movements and rigidity. Persistent weakness with depression of reflexes has also been observed. I t is hoped that the early initiation of heniodialysis treatment in serious lithium toxicity will prevent permanent neurological sequelae in the future.