title: Stabilization of the Serum Lithium Concentration by Regulation of Sodium Chloride Intake: Case Report.
abstract: To avoid fluctuation of the serum lithium concentration (CLi), sodium chloride (NaCl) intake was regulated in oral alimentation. A 62-year-old woman was hospitalized and orally administered 400 mg of lithium carbonate a day to treat her mania. Her CLi was found to be 0.75-0.81 mEq/L. Vomiting made it difficult for the patient to ingest meals orally, and therefore parenteral nutrition with additional oral intake of protein-fortified food was initiated. On day 22, parenteral nutrition was switched to oral alimentation to enable oral intake of food. The total NaCl equivalent amount was decreased to 1.2 g/d, and the CLi increased to 1.15 mEq/L on day 26. Oral alimentation with semi-solid food blended in a mixer was immediately initiated. Although the total NaCl equivalent amount was increased to 4.5-5.0 g/d, her CLi remained high at 1.14-1.17 mEq/L on days 33 and 49, respectively. We investigated oral administration of NaCl (1.8 g/d) on day 52. The total NaCl equivalent amount was increased to 6.3-6.8 g/d, and the CLi decreased to 1.08-0.97 mEq/L on days 63 and 104, respectively. After the start of the orally administered NaCl, her diet was changed to a completely blended diet on day 125. The total NaCl equivalent amount was increased to 9.0-14.5 g/d, and the CLi decreased to 0.53 mEq/L on day 152; therefore, the oral administration of NaCl was discontinued on day 166. The CLi was found to be 0.70-0.85 mEq/L on days 176 and 220.
authors.affiliation: Department of Pharmacy, Hospital Bando.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tomita
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Goto
authors.forename: Kenji
authors.initials: K
authors.lastname: Sumiya
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yukinao
authors.initials: Y
authors.lastname: Kohda
mesh_terms: D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy; D016903:Drug Monitoring; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008094:Lithium / Q000097:blood*; D016651:Lithium Carbonate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010288:Parenteral Nutrition; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
chemical_list: D018692:Antimanic Agents; D015415:Biomarkers; D017673:Sodium Chloride, Dietary; D016651:Lithium Carbonate; D008094:Lithium