HbA c SCr. /dl /dl +. SCr. /dl ml. meq/l 入院前内服薬 :. 入院時現症 : cm. kg BMI. JCS - GCS E V M BT BP / mmhg /min RR /min coase crakles + Babinski 入院時検査所見 (Tab
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1 症例報告 石井彰 1), 菅原斉 1), 渡辺珠美 1), 吉川修平 1), 田代研 1), 石岡春彦 2), 深津健 2), 大沼哲 2), 牛木真理子 2), 讃井將満 2) 1), 川上正舒 要 旨 HbA c +. meq/l Ⅰ 緒言 Ⅱ 症例症例 : 主訴 : 既往歴 : 家族歴 : 生活歴 : IT 喫煙 : ml/ 現病歴 : mg mg
2 HbA c SCr. /dl /dl +. SCr. /dl ml. meq/l 入院前内服薬 :. 入院時現症 : cm. kg BMI. JCS - GCS E V M BT BP / mmhg /min RR /min coase crakles + Babinski 入院時検査所見 (Table1) MRI Fig. -a Table 1. 受診時検査所見 Figure1-a: 受診時脳波 Ⅲ 入院後経過 (Fig.2) HD CHDF HD ml/h HF ml/h meq/l CHDF CHDF
3 / CTRX VCM HSV-IgM EEG Fig. -b Figure2 入院後経過 Figure1-b: 第 86 病日脳波 slurred speech MRI Fig. Ⅳ 考察 Dalton HbA c Na Na
4 mg Schou. mmol/l MRI Tesio MRI Schneider Bergmann s gliosis Ⅴ 結語 Figure3: 頭部 MRI の経時的変化文献 Suvisaari J, Perälä J, Saarni SI et al: Type diabetes among persons with schizophrenia and other psychotic disorders in a general population survey. Eur Arch Psychiatry Clin Neurosci : -,. Price LH, Heninger GR : Lithium in the treatment of mood disorders. N Engl J Med : -,. Blanka Kores and Malcolm H. Lader. : Irreversible lithium neurotoxicity. Clinical
5 Neuropharmacology vol : -,. Cohen D, Stolk RP, Grobbee DE et al : Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders. Diabetes Care : -,. Schou:Long-lasting neurological sequelae after lithium intoxication. Acta Psychiatr Scand : -,. Tesio L, Porta GL, Messa E: Cerebellar syndrome in lithium poisoning: a case of partial recovery. J Neurol Neurosurg Psychiatry :,. Schneider JA and Mirra SS: Neuropathologic correlates of persistent neurologic deficit in lithium intoxication. Ann Neurol : -,. Ferbert A and Czernik A: Persistent cerebellar syndrome following lithium poisoning, Nervenarzt : -,.
6 Jichi Medical University Journal Acute lithium toxicosis induced by the new onset of diabetes mellitus in a patient with bipolar disorder Akira ISHII, Hitoshi SUGAWARA, Tamami WATANABE, Shuhei YOSHIKAWA, Ken TASHIRO, Haruhiko ISHIOKA, Ken HUKATU, Tetsu OONUMA, Mariko USHIKI, Hiromitu SANUI, Masanobu KAWAKAMI Abstract The patient was a -year-old man with bipolar disorder who developed acute lithium toxicosis induced by the new onset of diabetes mellitus. He was being treated with lithium carbonate and presented with loss of consciousness. He had been drinking a large quantity of soft drinks because of increasing thirst over the previous months. At a regular hospital visit, his HbA c was found to be %. He was treated with oral hypoglycemic medication despite the presence of ketosis. Nine days later, he was transported to our hospital unconscious. His plasma lithium level was. meq/l. When he finally regained consciousness, he had severe residual cerebellar ataxia. Hypovolemia induced by high blood glucose causes prerenal acute renal failure. Once renal dysfunction has occurred, the serum lithium level quickly reaches toxic levels. Lithium toxicosis related to diabetes mellitus has rarely been reported. The mechanism of cerebellar ataxia due to lithium poisoning is not yet clear. This instructive case is presented along with a review of the relevant literature. Division of General Medicine, Clinical Department of Internal Medicine, Saitama Medical Center, Jichi Medical University Intensive Care Unit, Central Clinical Department, Saitama Medical Center, Jichi Medical University
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