Ke lawe nei ʻoe i ka lithium? A laila e makaʻala i kēia pōʻino! (Lithium Toxicity)

Ke hoʻohana nei ʻoe a i ʻole kekahi āu i ʻike ai i ka lithium, kahi lāʻau lapaʻau i kuhikuhi ʻia e nā kauka no kekahi mau kūlana olakino noʻonoʻo, ʻoi aku ka maʻi bipolar? ʻOiai hiki ke kōkua nui kēia lāʻau lapaʻau ke hoʻohana pono ʻia, ʻo ka lawe ʻana i ka nui loa hiki ke alakaʻi i kahi kūlana weliweli i kapa ʻia ʻo lithium toxicity. E kamaʻilio kākou e pili ana i kēia i kēia lā. I ka ʻōlelo maʻalahi, ʻo ka lithium toxicity ka wā e nui ai ka lithium i kou kino. Hiki i kēia ke hoʻonāukiuki i ka ʻōpū (e like me ka luaʻi ʻana, ka maʻi diarrhea) a me nā hōʻailona o ka ʻōnaehana nerve (e like me ka huikau, ka haʻalulu). Inā ʻaʻole mālama pono ʻia, hiki i kēia ke hoʻoweliweli i ke ola. He paʻakai kūlohelohe ka Lithium. Hoʻemi ia i ka mania. ʻO ia ke kumu e kuhikuhi pinepine ai nā kauka i kēia lāʻau lapaʻau no ka maʻi bipolar. Eia naʻe, he liʻiliʻi loa ka palena ma waena o kahi palekana a me ka weliweli o kēia lāʻau lapaʻau. ʻO ke ʻano o kēia, ʻoiai ka nui loa hiki ke hoʻomanawanui ʻole no ke kino.

Pehea e hiki ai ke loaʻa ka ʻona lithium?

Aia kekahi mau ala e hiki ai kēia ke hana. E nānā kākou i ke ʻano o lākou.

ʻAkika koʻikoʻi

Hana ʻia kēia inā lawe koke ʻoe i ka nui o nā pila lithium, a inā maloʻo loa kou kino. E noʻonoʻo e pili ana i ia mea, i kekahi manawa hana hewa ʻoe i ka wā e lawe ai i kāu lāʻau. Hiki ke hana ʻia kēlā.

ʻO ka lawe ʻana i nā mea ʻoi aku ma mua o kou pono i kēlā me kēia lā (Acute-on-chronic Toxicity)

Hiki ke hana ʻia kēia inā ʻoe e lawe mau i ka lithium i kēlā me kēia lā, akā i kekahi lā e lawe ʻoe i kahi mahele keu, a i ʻole inā e maloʻo kou kino i kekahi lā. Eia kekahi laʻana, inā ʻaʻole ʻoe e inu i ka wai lawa no ʻelua a ʻekolu paha lā, a inā ʻoe e luaʻi nui a nalowale ka wai mai kou kino.

ʻAʻai ʻino mau loa

Hana ʻia kēia no ka mea ke lawe ʻoe i ka lithium i kēlā me kēia lā, piʻi mālie ka nui o ka lithium i loko o kou kino a hōʻiliʻili i ka hala ʻana o ka manawa. Hiki ke hana maʻalahi kēia. Nui nā mea, e like me ka maloʻo ʻana o ka wai, ke olakino o nā puʻupaʻa, a me nā lāʻau lapaʻau ʻē aʻe āu e lawe ai, hiki ke hoʻopilikia i ke ʻano o ka lawelawe ʻana o kou kino i ka lithium.

He aha nā pae o ka make ʻana o ka lithium?

Nānā nā kauka i kāu mau pae lithium me kahi hoʻāʻo koko. Na kāu kauka e hoʻoholo i ka pae kūpono iā ʻoe. Ma keʻano laulā, ua māhele ʻia nā pae ʻawahia lithium penei:

• ʻAʻawahia iki: 1.5 a 2.5 mmol/L.
• ʻAkika waena: 2.5 a 3.5 mmol/L.
• ʻAkika nui: ʻOi aku ma mua o 3.5 mmol/L.

ʻAʻole pono ʻoe e noʻonoʻo nui e pili ana i kēia anakahi i kapa ʻia he millimoles (`mmol/L`), he mea nui ia i nā kauka. ʻO ka mea nui iā ʻoe, ʻo ia ka makaʻala i nā hōʻailona.

He aha nā hōʻailona o ka make ʻana o ka lithium?

Hiki ke ʻokoʻa kēia mau hōʻailona ma muli o ke ʻano o ka lāʻau make a me kona koʻikoʻi.

Nā hōʻailona o ka lāʻau make koke a me ka make koke

I nā manawa e like me kēia, ʻo ka mea mua e hiki mai ana i ka noʻonoʻo, ʻo ia nā pilikia ʻōpū (Gastrointestinal - GI problems). ʻO ia hoʻi:

• Ka luaʻi a me ka luaʻi .
• Ka luaʻi ʻana (ka maʻi kahe).
• ʻeha ka ʻōpū .
• Manaʻo ua piha kou ʻōpū.

Hoʻomaka pinepine kēia mau hōʻailona i loko o hoʻokahi hola o ka lawe ʻana i ka nui o ka lithium.

Mea nui: Inā loaʻa kēia mau hōʻailona, ​​​​he mea nui loa e ʻimi koke i ke kōkua lapaʻau.

Inā he waena a koʻikoʻi paha ka lāʻau make, hiki i nā hōʻailona e pili ana i ka ʻōnaehana nerve ke hahai i ka ʻeha o ka ʻōpū. ʻO kēia mau mea:

• Nā loli i ke kūlana noʻonoʻo: Hiki ke ʻano mai ka huikau iki a i ka delirium koʻikoʻi.
• Haʻalulu hiki ʻole ke kāohi ʻia (Tremors).
• Ka nalowale o ke kaulike a me ka hoʻonohonoho ʻana i ka wā e hele ana a kū paha ('Ataxia').
• ʻŪmiʻi ʻana o nā ʻiʻo (`Myoclonus`).
• Ka hūpō o ka ʻōlelo ('Dysarthria').
• Hyperreflexia (ka pane nui ʻana).
• Ka neʻe ʻana o nā maka i kāohi ʻole ʻia (Nystagmus).
• I nā hihia koʻikoʻi, piʻi ka wela (Hyperthermia).
• I nā hihia koʻikoʻi, nā ʻōkuʻi .
• I nā hihia koʻikoʻi, nalowale ka ʻike (`Coma`).

Inā ʻoe e lawe ana i ka lithium a ʻike i kekahi o kēia mau hōʻailona, ​​​​pono ʻoe e ʻike koke i ke kauka.

Nā Hōʻailona o ka Lithium Toxicity Mau Loa

Ke ʻai ʻia ka lithium no kahi manawa lōʻihi, hiki iā ia ke hōʻino pinepine i nā puʻupaʻa. Hiki i kēia ke alakaʻi i nā ʻano maʻi puʻupaʻa like ʻole, kēlā me kēia me kāna mau hōʻailona ponoʻī. Eia kekahi o nā kūlana e hiki ke hana:

ʻO ka maʻi diabetes insipidus nephrogenic

ʻO kēia ka manawa hiki ʻole i kou mau puʻupaʻa ke kaulike pono i nā wai i loko o kou kino. ʻAʻole hiki iā lākou ke pane pono i ka hormone antidiuretic (ADH). Eia nā hōʻailona:

• Ka maloʻo ʻana o ka wai: Waha maloʻo, luhi, a me ka poniuniu.
• Manaʻo nui i ka makewai (' Polydipsia' ).
• Ka hele nui ʻana o ka mimi ('Polyuria').

ʻO ka Nephritis nalowale sodium

Ma kēia, ʻo ka hōʻino ʻana i nā puʻupaʻa ke kumu o nā kaulike ʻole electrolyte i loko o ke kino. ʻO nā hōʻailona penei:

• Ke huli nei ka ʻiʻo a lilo i mea nāwaliwali.
• Nā loli i ke kūlana noʻonoʻo.
• Luhi.
• Ka makewai nui.
• Ka mimi nui ʻana (polyuria).

ʻO ka maʻi Nephrotic

Ma kēia kūlana, hoʻokuʻu nui kou mau puʻupaʻa i ka protein i loko o kou mimi ('Proteinuria'). Nā hōʻailona:

• Hoʻonui ʻia ka cholesterol (Hyperlipidemia).
• Ka pehu ʻana o nā wāwae a me nā kuʻekuʻe wāwae (`Edema`).
• ʻAʻohe ʻono o ka meaʻai.
• ʻeha ka ʻōpū.
• Ke huʻa nei ka mimi.

Hiki ke loaʻa nā pilikia o ka ʻōnaehana endocrine ma muli o ka lāʻau make lithium i kahi manawa lōʻihi. Nā Laʻana:

• Hoʻemi ʻia ka hana thyroid ('Hypothyroidism').
• Hoʻonui ʻia ka hana o ka ʻōpū thyroid ('Hyperthyroidism').
• Hoʻonui ʻia ka hana o nā ʻāpana parathyroid (hyperparathyroidism).

Inā ʻike ʻoe i kekahi o kēia mau hōʻailona i ka wā e lawe ana i ka lithium, e kamaʻilio me ke kauka i ka wā hikiwawe loa.

ʻO ka pilina ma waena o ka lithium a me ka serotonin syndrome

Hiki i ka Lithium ke hana i kahi maʻi i kapa ʻia ʻo serotonin syndrome. He kiʻekiʻe loa kēia pilikia inā ʻoe e lawe ana i nā lāʻau lapaʻau ʻē aʻe e hoʻopilikia ana i nā pae serotonin. Hiki i kēia ke hoʻoweliweli i ke ola. Nā hōʻailona o ka serotonin syndrome (mai ka ʻoluʻolu a i ka koʻikoʻi):

• Hoʻomaha ʻole.
• Ka luaʻi a me ka luaʻi.
• Ka maʻi pākī.
• Lilo nā haumāna o nā maka i mea nui aʻe.
• Haʻalulu.
• Hopohopo, hoʻomaha ʻole.
• Ke wili ʻana a me ke kaomi ʻana i nā ʻiʻo pōpō palaoa.
• Ke hou nei a me ka haʻalulu.
• Ka huikau, ka nalowale o ka ʻike (Delirium).
• Nā palpitations o ka puʻuwai.
• Ke koko kiʻekiʻe.

Inā loaʻa iā ʻoe kēia mau hōʻailona, ​​e ʻimi koke i ke kōkua lapaʻau!

He aha nā kumu o ka make ʻana o ka lithium?

ʻEkolu mau kumu nui no kēia:

• ʻAi nui ʻana i ka lithium: ʻO ka lawe ʻana i nā pila lithium he nui loa, me ka manaʻo a i ʻole ka ulia pōpilikia, hiki ke hoʻoulu i ka ʻawaʻawa koke a i ʻole ka ʻawaʻawa mau loa. Hiki nō hoʻi kēia ke hana inā hoʻonui nui ke kauka i kāu mahele lāʻau, akā he mea kākaʻikahi loa kēia.
• Ka maloʻo ʻana o ka wai a i ʻole nā ​​loli wai: ʻO kēia ke kumu maʻamau. Ke nalowale ke kino i ka sodium (paʻakai) a me ka wai, hoʻopili hou nā puʻupaʻa i ka lithium. Hoʻonui kēia i ka nui o ka lithium i loko o ke koko. ʻO nā kumu paha:
• I ka wā e luaʻi ana.
• Ke hiki mai ka maʻi diarrhea.
• Ke loaʻa iā ʻoe ke kuni.
• Ka hāʻule ʻana o nā puʻupaʻa.
• I ka wā e lawe ana i nā lāʻau lapaʻau e hoʻoulu ai i ka mimi, e like me ka diuretics.
• I ka wā e hoʻoikaika kino nui ai.
• Ka hou nui ʻana (Hyperhidrosis).
• E like me ka wā e inu ʻole ai ʻoe i ka wai.
• I ka ʻai ʻana i ka papaʻai haʻahaʻa paʻakai.
• Nā maʻi puʻuwai ('Congestive heart failure').
• I ka wā hāpai a hānau keiki paha.
• Nā loli o ke kelepa thyroid ('Hyperthyroidism').
• Nā pilikia me ka hoʻokuʻu ʻana o ka lithium: I kekahi manawa ʻaʻole hiki i ke kino ke hoʻokuʻu pono i ka lithium. Hiki nō hoʻi kēia ma muli o nā kumu i ʻōlelo ʻia ma luna.

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia no ka lithium toxicity?

ʻOi aku ka nui o ka pilikia o ka poʻe ma lalo nei no ka ʻawahia lithium mau loa:

• Nā kānaka ma luna o 50 mau makahiki.
• ʻO nā kānaka me ka maʻi thyroid.
• ʻO nā kānaka me ka hana puʻupaʻa maikaʻi ʻole.
• ʻO nā kānaka me ka maʻi diabetes insipidus.

ʻOiai inā ʻoe e hoʻohana i ka lithium no ka manawa lōʻihi, aia ʻoe i ka nui o ka pilikia o ka hoʻomohala ʻana i ka nephrogenic diabetes insipidus, ka mea i hoʻokumu ʻia e ka lithium. Hiki i kēia ke alakaʻi i ka lithium toxicity. Inā loaʻa iā ʻoe kekahi o kēia mau kūlana i ka wā e lawe ana i ka lithium, e kamaʻilio me kāu kauka.

Pehea e ʻike ai nā kauka i ka ʻawahia o ka lithium?

No ka ʻike pono i ke koʻikoʻi o kēia, he mea nui loa kēia ʻike no nā kauka:

• ʻEhia ka nui o ka lithium āu i lawe ai?
• I ka manawa hea ʻoe i lawe ai?
• Akā ua lawe anei ʻoe i kekahi mau lāʻau lapaʻau ʻē aʻe a i ʻole nā ​​​​mea ʻē aʻe i ka manawa like?
• He hana manaʻo anei kēia a he kuhihewa paha?

No ka hōʻoia ʻana i ka ʻawahia o ka lithium, hana nā kauka i kekahi mau hoʻokolohua. ʻO kekahi o lākou:

• Nā hoʻāʻo koko e nānā i ka pae o ka lithium i loko o kou koko.
• Nā hoʻāʻo koko e nānā i nā pae o nā electrolytes (e like me ka sodium a me ka calcium) i loko o kou koko.
• Nā hoʻāʻo koko e nānā i nā pae o ka hormone hoʻoulu thyroid (TSH).
• Ka nānā ʻana i ka mimi.
• Nā hoʻokolohua hana puʻupaʻa (e like me ka urea koko a me nā pae creatinine).
• Nā hoʻokolohua kiʻi lolo (hana kākaʻikahi ʻia kēia).

E nānā pū nā kauka i kou olakino no nā mea e like me:

• Kou puʻuwai me kahi `EKG` (electrocardiogram).
• ʻEhia kou mimi ʻana (ka nui o ka mimi i hoʻopuka ʻia).
• Kou pae oxygen - i ana pinepine ʻia me ka `pulse oximeter` (`pulse ox`).

Pehea e mālama ʻia ai ka ʻawahia lithium?

ʻOkoʻa ka mālama ʻana no ka lāʻau make lithium ʻoi a me ka ʻoi ma ke ʻano mau ma muli o ke koʻikoʻi a me ka wikiwiki o kou hiki ʻana i ka lumi pilikia. ʻO nā pahuhopu nui ka wehe ʻana i ka lithium mai kou kino a kāohi i kāu mau hōʻailona. Hiki i ka mālama ʻana ke komo pū me:

• Holoi ʻōpū.
• Hoʻoinu wai ʻōpū holoʻokoʻa: ʻO kēia ka hāʻawi ʻana i kahi wai kūikawā ma ka waha a i ʻole ma o kahi paipu i hoʻokomo ʻia ma ka ihu i loko o ka ʻōpū. Hoʻopau kēia i nā lithium āpau mai ke ala gastrointestinal.
• ʻAla kālā i hoʻāla ʻia: Hāʻawi ʻia kēia inā ua lawe ʻoe i nā lāʻau lapaʻau ʻē aʻe a i ʻole nā ​​​​mea ʻē aʻe.
• Hemodialysis: ʻO kēia ke ala nui e wehe ai i ka lithium mai nā puʻupaʻa.
• Ke hāʻawi ʻana i ka saline ('IV fluids').
• Hoʻōla nā lāʻau lapaʻau like ʻole i nā hōʻailona.

ʻO ka hapa nui o ka manawa, e mālama ʻia ʻoe ma kahi lumi pilikia. Inā koʻikoʻi ka lāʻau ʻona, pono paha ʻoe e mālama ʻia ma kahi keʻena mālama koʻikoʻi (ICU).

Lapaʻau no ka Lithium Toxicity Mau Loa

ʻO ka lāʻau make lithium no ka manawa lōʻihi e hōʻino pinepine ai i nā puʻupaʻa. Aia ka lāʻau lapaʻau i ke ʻano o ka pilikia o ka puʻupaʻa. Pono paha ka hemodialysis.

He aha nā manawa kūpono e ho'ōla ai i kēia kūlana? (Prognosis)

ʻO ka hoʻōla ʻana mai ka ʻawahia lithium e pili ana i ke ʻano o ka lāʻau make, pehea kona koʻikoʻi, a me ka wikiwiki o kou ʻimi ʻana i ke kōkua lapaʻau. ʻO ka poʻe i loaʻa ʻole nā ​​​​hōʻailona neurological mai ka ʻawahia lithium koʻikoʻi, ʻaʻole lākou e loaʻa nā pilikia lōʻihi. Eia nō naʻe, inā loaʻa iā ʻoe nā hōʻailona neurological koʻikoʻi, hiki iā lākou ke mau loa. ʻO ia ke kumu he mea nui ka mālama koke ʻana. I nā hihia koʻikoʻi, hiki i ka ʻawahia lithium ke alakaʻi i ka coma, ka hōʻino ʻana o ka lolo, a i ʻole ka make. Hiki ke paʻakikī ke ʻike i ka ʻawahia lithium mau loa no ka mea hiki ke ulu aʻe nā hōʻailona i ka hala ʻana o ka manawa. Hiki i kēia lohi ke alakaʻi i nā pilikia puʻupaʻa a me ka ʻōnaehana nerve no ka manawa lōʻihi.

Pehea e pale aku ai i ka make ʻana o ka lithium?

Ma hope o kēia mau hana e hiki ai ke kōkua i ka pale ʻana i ka ʻawahia lithium koʻikoʻi:

• E lawe i kāu mau lāʻau lapaʻau e like me ke kauoha: E lawe wale i ka nui o ka lithium (a me nā lāʻau lapaʻau ʻē aʻe) i kauoha ʻia e kāu kauka. E mālama i kahi lepili ma kāu mau ʻōmole lāʻau lapaʻau, a i ʻole e kākau i nā manawa āu e lawe ai. Hiki i kēia ke kōkua iā ʻoe e pale aku i ka lawe ʻana i kahi mahele pālua.
• E mālama pono i kāu lāʻau lithium: E mālama iā ia mai ka hiki ʻana aku o nā keiki a me nā poʻe ʻē aʻe.
• E noho wai:E inu i ka wai he nui. Hiki i ka maloʻo ke hoʻoulu i ka ʻawahia o ka lithium. E haʻi i kāu kauka inā loaʻa iā ʻoe ka luaʻi, ka maʻi pākī, a i ʻole ke kuni.
• E haʻi mau i kāu kauka i kahi papa inoa o nā lāʻau lapaʻau āpau āu e lawe ai: Ma mua o ka hoʻomaka ʻana i kahi lāʻau lapaʻau hou, e haʻi i kāu kauka e lawe ana ʻoe i ka lithium (a me nā lāʻau lapaʻau ʻē aʻe). Hiki i kekahi mau lāʻau lapaʻau ke hoʻopilikia i ke ʻano o kou kino e lawelawe ai i ka lithium.
• E haʻi i kāu kauka inā loaʻa iā ʻoe kekahi mau loli hou a koke paha i kou olakino: no ka laʻana, ka hāpai ʻana a me nā loli hormonal (endocrine).

Inā loaʻa iā ʻoe nā manaʻo pepehi kanaka, a inā paha ʻoe e noʻonoʻo ana e lawe nui i ka lithium ma ke ʻano hana, e ʻoluʻolu e hele i ka ʻoihana pilikia o ka haukapila kokoke loa, a i ʻole e kamaʻilio me kahi mea āu e hilinaʻi ai. Ma Sri Lanka, hiki iā ʻoe ke loaʻa ke kōkua mai nā hui e like me Sumithrayo (helu kelepona 0112692909 a i ʻole 0112682535).

Inā ʻoe e lawe ana i ka lithium no ka manawa lōʻihi, e paipai paha kāu kauka i nā hoʻāʻo koko a me ka mimi maʻamau e nānā i kou olakino. Hiki i kēia mau hoʻāʻo ke kōkua i ka ʻike mua ʻana i ka ʻawahia lithium mau loa. Eia nā hoʻāʻo a me nā alakaʻi:

• Nānā ʻia nā pae Lithium i loko o ke koko i loko o ʻekolu a ʻelima mau lā ma hope o ka hoʻomaka ʻana o ka lithium a i ʻole ka hoʻololi ʻana i ka dosage.
• No ka poʻe e lawe ana i ka lāʻau lapaʻau no ka manawa lōʻihi , e nānā ʻia nā pae lithium i loko o ke koko i kēlā me kēia ʻekolu a ʻeono mahina.
• Hoʻopaʻa ʻia nā pae electrolyte, urea, a me creatinine i kēlā me kēia ʻekolu a ʻeono mahina.
• Hoʻopaʻa ʻia nā pae calcium a me ka hormone hoʻoulu thyroid (TSH) i kēlā me kēia ʻeono a ʻumikūmālua mahina.

ʻO ka mea hope loa, nā mea e hoʻomanaʻo ai

He lāʻau lapaʻau ikaika loa ka Lithium a he pono hoʻi, akā pono ia i ka mālama pono ʻana i ka wā e hoʻohana ai. ʻO ka ʻawahia o ka Lithium kahi pilikia e hoʻoweliweli ai i ke ola e hiki ke loaʻa mai ka lawe ʻana i ka nui o ka lāʻau lapaʻau a i ʻole ka nalowale ʻana o ka wai nui i ka wā e lawe ana i ka lāʻau. E kamaʻilio me kāu kauka e pili ana i nā ala e pale aku ai i ka ʻawahia o ka lithium a me nā hōʻailona e makaʻala ai. Aia nā kauka ma laila e kōkua iā ʻoe a mālama iā ʻoe i ke olakino. No laila, mai makaʻu e nīnau inā he mau nīnau a hopohopo paha kāu. E hoʻomanaʻo, ʻo ka mea nui loa, ʻo ia ka lawe ʻana i kāu lāʻau lapaʻau e like me ke kuhikuhi a kāu kauka, i nā manawa kūpono. Eia kekahi, mai poina e inu i nā wai he nui.