{"title":"用一种创新的治疗方法对患有双相情感障碍和慢性肾脏疾病的老年人给予锂离子治疗的案例研究","authors":"R. Burns","doi":"10.33844/cjm.2022.6024","DOIUrl":null,"url":null,"abstract":"The case follows the treatment of a woman from age 73 to age 83 who was bipolar and who also had Chronic Kidney Disease (CKD). During the study, the eGFR dropped from 43 to below 20. Initially the treatment was fairly standard but highlighted the difficulty of knowing when to reduce the lithium dose before undesired mood changes occurred. In phase 2 of the treatment, the usual monthly blood serum test is combined with a new concept of a monthly running average eGFR to decide when to reduce the lithium dose. A new way of administering lithium was created which was used when the patient’s daily dose of lithium reached 300mg a day. In place of a fixed daily dose of lithium, a fixed average daily dose of lithium over a short cyclic pattern was used. The daily dose varies within the repeatable cycle but is smoothed out by the long half-life of lithium. The new method allows for the reduction of the lithium dose by small amounts, less than the minimum strength 150mg capsule used in North America or the 100mg tablet used in Europe. The method has been successfully used for several years with the patient’s moods stable and lithium toxicity avoided. The patient is currently on an average daily dose of 187mg a day with an eGFR less than 20.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":null,"pages":null},"PeriodicalIF":0.7000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Case Study of Administering Lithium to a Senior Who is Bipolar and Who Also has Chronic Kidney Disease Using an Innovative Treatment Method\",\"authors\":\"R. Burns\",\"doi\":\"10.33844/cjm.2022.6024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The case follows the treatment of a woman from age 73 to age 83 who was bipolar and who also had Chronic Kidney Disease (CKD). During the study, the eGFR dropped from 43 to below 20. Initially the treatment was fairly standard but highlighted the difficulty of knowing when to reduce the lithium dose before undesired mood changes occurred. In phase 2 of the treatment, the usual monthly blood serum test is combined with a new concept of a monthly running average eGFR to decide when to reduce the lithium dose. A new way of administering lithium was created which was used when the patient’s daily dose of lithium reached 300mg a day. In place of a fixed daily dose of lithium, a fixed average daily dose of lithium over a short cyclic pattern was used. The daily dose varies within the repeatable cycle but is smoothed out by the long half-life of lithium. The new method allows for the reduction of the lithium dose by small amounts, less than the minimum strength 150mg capsule used in North America or the 100mg tablet used in Europe. The method has been successfully used for several years with the patient’s moods stable and lithium toxicity avoided. The patient is currently on an average daily dose of 187mg a day with an eGFR less than 20.\",\"PeriodicalId\":44615,\"journal\":{\"name\":\"Canadian Journal of Rural Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2022-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Rural Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.33844/cjm.2022.6024\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Rural Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.33844/cjm.2022.6024","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
A Case Study of Administering Lithium to a Senior Who is Bipolar and Who Also has Chronic Kidney Disease Using an Innovative Treatment Method
The case follows the treatment of a woman from age 73 to age 83 who was bipolar and who also had Chronic Kidney Disease (CKD). During the study, the eGFR dropped from 43 to below 20. Initially the treatment was fairly standard but highlighted the difficulty of knowing when to reduce the lithium dose before undesired mood changes occurred. In phase 2 of the treatment, the usual monthly blood serum test is combined with a new concept of a monthly running average eGFR to decide when to reduce the lithium dose. A new way of administering lithium was created which was used when the patient’s daily dose of lithium reached 300mg a day. In place of a fixed daily dose of lithium, a fixed average daily dose of lithium over a short cyclic pattern was used. The daily dose varies within the repeatable cycle but is smoothed out by the long half-life of lithium. The new method allows for the reduction of the lithium dose by small amounts, less than the minimum strength 150mg capsule used in North America or the 100mg tablet used in Europe. The method has been successfully used for several years with the patient’s moods stable and lithium toxicity avoided. The patient is currently on an average daily dose of 187mg a day with an eGFR less than 20.
期刊介绍:
The Canadian Journal of Rural Medicine (CJRM) is a quarterly peer-reviewed journal available in print form and on the Internet. It is the first rural medical journal in the world indexed in Index Medicus, as well as MEDLINE/PubMed databases. CJRM seeks to promote research into rural health issues, promote the health of rural and remote communities, support and inform rural practitioners, provide a forum for debate and discussion of rural medicine, provide practical clinical information to rural practitioners and influence rural health policy by publishing articles that inform decision-makers.