A 36-year-old man with underlying systemic lupus erythematosus complicated by autoimmune hemolytic anemia underwent immunosuppressive treatment. After showing a low-grade fever for two days, his fever spiked. He was confirmed to have pandemic (H1N1) 2009 by real-time reverse transcription polymerase chain reaction (PCR). His condition deteriorated to acute respiratory distress syndrome (ARDS), and mechanical ventilation became necessary. The lowest PaO2/FIO2 ratio was 77, and he was placed on extracorporeal membrane oxygenation (ECMO). Based on our observation, the emergency use of ECMO in addition to peramivir might be useful. A noteworthy point is that once ARDS deteriorates due to pandemic (H1N1) 2009, intensive supportive care should be started.
Key words:acute lithium toxicity, intermittent hemodialysis, bipolar disorder 〈Abstract〉 A 66-year-old man, who was receiving oral treatment for bipolar disorder, was admitted to a psychiatric hospital for the treatment of agonistic behavior. He was prescribed lithium carbonate to gradually settle his excited state;however, the patient exhibited drowsiness after lithium carbonate was administration. On examination, the serum concentration of lithium carbonate was found to be high(3.4 mEq/L) ;therefore, he was transferred to our hospital by ambulance for the restoration of normal serum lithium carbonate levels. Lithium toxicity was suspected, and we performed 4 hours of daily hemodialysis for 6 days. The serum concentration of lithium carbonate decreased to less than 1.0 mEq/L on day 3 of hospitalization. He was completely conscious and his involuntary movements disappeared on day 7 of hospitalization, at which time hemodialysis was stopped. He was transferred to the previous hospital on day 9. This case shows that intermittent hemodialysis is an effective and sufficient treatment for lowering the serum concentration of lithium in a short period in acute lithium toxicity patients who have just started to take lithium carbonate.
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