Stabilization of the Serum Lithium Concentration by Regulation of Sodium Chloride Intake: Case Report

Yakugaku Zasshi. 2016;136(3):517-21. doi: 10.1248/yakushi.15-00256.

Abstract

To avoid fluctuation of the serum lithium concentration (CLi), sodium chloride (NaCl) intake was regulated in oral alimentation. A 62-year-old woman was hospitalized and orally administered 400 mg of lithium carbonate a day to treat her mania. Her CLi was found to be 0.75-0.81 mEq/L. Vomiting made it difficult for the patient to ingest meals orally, and therefore parenteral nutrition with additional oral intake of protein-fortified food was initiated. On day 22, parenteral nutrition was switched to oral alimentation to enable oral intake of food. The total NaCl equivalent amount was decreased to 1.2 g/d, and the CLi increased to 1.15 mEq/L on day 26. Oral alimentation with semi-solid food blended in a mixer was immediately initiated. Although the total NaCl equivalent amount was increased to 4.5-5.0 g/d, her CLi remained high at 1.14-1.17 mEq/L on days 33 and 49, respectively. We investigated oral administration of NaCl (1.8 g/d) on day 52. The total NaCl equivalent amount was increased to 6.3-6.8 g/d, and the CLi decreased to 1.08-0.97 mEq/L on days 63 and 104, respectively. After the start of the orally administered NaCl, her diet was changed to a completely blended diet on day 125. The total NaCl equivalent amount was increased to 9.0-14.5 g/d, and the CLi decreased to 0.53 mEq/L on day 152; therefore, the oral administration of NaCl was discontinued on day 166. The CLi was found to be 0.70-0.85 mEq/L on days 176 and 220.

Publication types

  • Case Reports

MeSH terms

  • Antimanic Agents / administration & dosage*
  • Antimanic Agents / adverse effects
  • Biomarkers / blood
  • Bipolar Disorder / blood
  • Bipolar Disorder / drug therapy
  • Drug Monitoring
  • Drug Overdose / blood
  • Drug Overdose / diagnosis
  • Drug Overdose / prevention & control*
  • Enteral Nutrition
  • Female
  • Humans
  • Lithium / blood*
  • Lithium Carbonate / administration & dosage*
  • Lithium Carbonate / adverse effects
  • Middle Aged
  • Parenteral Nutrition
  • Sodium Chloride, Dietary / administration & dosage*

Substances

  • Antimanic Agents
  • Biomarkers
  • Sodium Chloride, Dietary
  • Lithium Carbonate
  • Lithium