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.
Keywords: colpocleisis, long-term hemodialysis, pelvic, ureteral and bladder cancer, urinary tract cancer 〈Abstract〉 A 69-year-old female who had been on hemodialysis because of chronic glomerulonephritis since the age of 53 was admitted to our department with a complaint of macroscopic hematuria. Bladder fiberscopy revealed a few small bladder tumors, which were removed using transurethral resection(TURBT). Thereafter, plain computed tomography(CT) , bladder fiberscopy, and washing cytology were performed to detect recurrence. Three years after the TURBT, plain CT revealed right-sided renal cancer. Therefore, a laparoscopic right-sided retroperitoneal nephrectomy was carried out. A histopathological examination demonstrated right-sided renal pelvic carcinoma. In addition, at 1 month after the nephrectomy plain CT showed left-sided ureteral cancer, and retroperitoneal laparoscopic total left nephroureterectomy, total bladder cystectomy, and residual right ureterectomy were performed. Colpocleisis for a transvaginal enterocele was conducted at 1 postoperative year. The patient has not suffered any other complications since. It is often difficult to detect urothelial tumors in hemodialysis patients because they can suffer from oliguria or anuria; therefore, such tumors tend to be diagnosed late. Many hemodialysis patients develop urinary tract tumors, such as kidney or bladder tumors, and clinicians should examine such patients for accompanying pelvic or ureteral tumors. Here, we report the case of this hemodialysis patient along with a review of the relevant literature.
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