[Standard perioperative management of patients treated with lithium can lead to hyperosmolar coma].
A 55-year-old woman with bipolar disorder who had been taking lithium for several years developed hyperosmolar coma following osteosynthesis of a hip fracture. The coma was attributed to decompensation of undiagnosed nephrogenic diabetes insipidus due to chronic lithium intake. The lengthy perioperative fasting and large fluid loading (necessitated by the anesthetic technique) led to acute hypernatremia. Closer monitoring and a different anesthetic strategy might have avoided this classical complication of chronic lithium therapy. The patient recovered after symptomatic treatment. We discuss the perioperative management of patients taking (or having taken) lithium, based on a review of the literature.
Vergnaud
E
E
Service de réanimation polyvalente, centre hospitalier d'Angoulême, hôpital Girac, 16470 Saint-Michel, France.
Baudin
O
O
Desachy
A
A
D000775:Anesthesia, Spinal; D001714:Bipolar Disorder / Q000188:drug therapy; D001834:Body Water / Q000378:metabolism; D003128:Coma / Q000209:etiology*; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced / Q000150:complications*; D004809:Ephedrine / Q000627:therapeutic use; D005215:Fasting / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D006955:Hypernatremia / Q000209:etiology*; D007684:Kidney Tubules / Q000187:drug effects; D016651:Lithium Carbonate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009994:Osmolar Concentration; D010952:Plasma Substitutes / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods
D010952:Plasma Substitutes; D016651:Lithium Carbonate; D004809:Ephedrine