Drug-induced lithium toxicity in the elderly: A population-based study
Drug-induced lithium toxicity in the elderly: A population-based study
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DOI：
10.1111/j.1532-5415.2004.52221.x
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发表时间：
2004-05-01
影响因子：
6.3
通讯作者：
Redelmeier, DA
中科院分区：
文献类型：
--
作者：
Juurlink, DN;Mamdani, MM;Redelmeier, DA
目的：研究老年人因锂中毒入院与使用利尿剂、血管紧张素转换酶 (ACE) 抑制剂和非甾体抗炎药 (NSAID) 之间的关系。设计：基于人群的巢式病例对照研究。地点：加拿大安大略省。参与者：接受锂治疗的 66 岁及以上安大略省居民。测量：估计因锂入院的相对风险结果：从1992年1月到2001年12月，共确定了10615名持续接受锂治疗的老年患者，其中413人（3.9%）因锂中毒至少入院一次。调整潜在混杂因素后，开始使用袢利尿剂（相对风险 (RR)=5.5，95% 置信区间 (CI)=1.9-16.1）或 ACE 抑制剂（RR=7.6，95% CI=2.6-22.0）治疗一个月内，锂中毒风险显着增加。相反，噻嗪类利尿剂和 NSAID 均与锂中毒住院风险显着增加无关。结论：使用袢利尿剂或 ACE 抑制剂会显着增加锂中毒住院风险，特别是对于初次接受者。
OBJECTIVES: To study the association between hospital admission for lithium toxicity and the use of diuretics, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly.DESIGN: Population-based nested case-control study.SETTING: Ontario, Canada.PARTICIPANTS: Ontario residents aged 66 and older treated with lithium.MEASUREMENTS: Estimated relative risk of hospital admission for lithium toxicity.RESULTS: From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithium toxicity. After adjustment for potential confounders, a dramatically increased risk of lithium toxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9-16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6-22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithium toxicity.CONCLUSION: The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naive recipients.