RESUMO
Introduction: As bipolar disorder often requires long-term lithium treatment, assessment of adverse effects is critical. Long-term treatment with lithium induces functional and / or structural disturbances in the kidneys. Nephrogenic diabetes insipidus (NDI) occurs in up to 40% of lithium users and leads to a 2-3 times increased risk of chronic kidney disease. Polyuria-associated fluid imbalances and NDI, increase the risk of hypernatremia. Without appropriate and quick treatments, hypernatremia can easily lead to life-threatening consequences. A major adverse effect, hypernatremia secondary to kidney injury induced by lithium should not be misdiagnosed. We report cases of three patients with mood disorders treated with long-term lithium therapy. They presented to our hospital during the state of emergency declared by the Japanese government in response to curb the coronavirus disease (COVID-19) pandemic. They showed hypernatremia and disturbance of consciousness. All three patients had been taking lithium for more 10 years and had dehydration and / or renal damage on admission. The main cause of clinically significant hypernatremia is not drug-induced kidney injury after long-term lithium treatment, but lithium is one of the most common causes of acquired NDI. Case Report: Case 1 A 65-year-old man with a history of bipolar disorder and presented with polyurea, dehydration, and altered consciousness. He had been on lithium carbonate (800 mg twice daily) for over 20 years. Case 2 A 58-year-old woman with recurrent depressive disorder presented with high fever, drowsiness, spasms, and a highly serum creatine phosphokinase. She was admitted to the emergency department to rule out neuroleptic malignant syndrome. She was prescribed lithium carbonate (800 mg twice daily), but was not fully compliant with the treatment. Case 3 A 72-year-old-woman with bipolar disorder and history of hospitalizations at a mental-health rehabilitation institution presented with disturbance of consciousness and psychomotor retardation. She had been on lithium carbonate (400 mg twice daily) for 16 years. Oral dyskinesia and dysarthria were observed as were high fever and confusion. Of the three patients, one was a COVID-19 patient, while the others were not: however, all of them showed hypernatremia. A cohort study showed that infection, intoxication other than lithium, and dehydration were the main causes of hypernatremia. Lithium intoxications only accounted for 1% of all hypernatremia episodes. Probably the COVID-19 infection may directly cause hypernatremia, and dehydration may indirectly cause hypernatremia owing to a close ward, delirium, and physical restraint because they cannot complain about thirst. The COVID-19 pandemic affects the mental health of patients with bipolar disorder. Amounts of alcohol, soft drinks, and food can potentially trigger symptoms of kidney injury and diabetes. Conclusion: These patients with mood disorders after long-term lithium therapy must be carefully monitored their mental condition, including delirium, their complaints, and laboratory data to avoid overlooking severe conditions. [1,2]
RESUMO
Background: In December Of 2019, Coronavirus Disease 2019 (Covid-19) Emerged In Wuhan. The Government Of Japan Declared A “State Of Emergency” On April 16, 2020. Although This Approach Was Partially Successful For Temporarily Stopping The Spread, Concerns Were Raised Regarding The Negative Impact Of These Measures, Not Only In Terms Of Economics, But Also In Terms Of Mental And Physical Health, Such As Anxiety And Depression. Inflammatory Bowel Diseases (Ibd) Are Intestinal Disorders Affected By Environmental Factors, Such As Sleep, Stress, Diet, And Smoking. Therefore, This Study Aimed To Assess The Effects Of The Covid-19 Pandemic And State Of Emergency On The Lifestyle And Disease Activity Of Patients With Ibd. Methods: We Conducted A Questionnaire Survey In Ibd Patients With Regular Follow-Up At Osaka City University Hospital In Japan, From June 16 To August 21, 2020. The Questionnaire Included Questions Regarding The Patient’S Epidemiological History Of Covid-19, Demographic Data, Gastrointestinal Symptoms, Lifestyle Changes And Stress Related To The State Of Emergency, And Current Medication Use. Gastrointestinal Symptoms Were Assessed Before And During The State Of Emergency Using The 6-Point Mayo Score9 And Patient-Reported Outcome 2 (Pro2) Score10 For Ulcerative Colitis (Uc) And Crohn’S Disease (Cd), Respectively. Results: Overall, 451 Patients Completed The Survey. Patients With Exacerbated Uc Tended Have Younger Age, Less Sleep, And More Stress Against Covid-19 Than Did Patients With Non-Exacerbated Uc. Figure 1 Summarizes The Lifestyle Changes And Stress Related To The State Of Emergency. Patients With Exacerbated Uc Tended Have Younger Age, Less Sleep, And More Stress Against Covid-19 Than Did Patients With Non-Exacerbated Uc. Multivariate Logistic Regression Analysis Identified Younger Age (Odds Ratio [Or] 1.020, 95% Confidence Interval [Ci] 1.010-1.040;P = 0.011), Fewer Sleep Hours (Or 1.320, 95% Ci 1.020-1.720;P = 0.035), And Increased Stress Due To The Covid-19 Pandemic (Or 5.530, 95% Ci 1.650-18.500;P < 0.01) As Independent Risk Factors Associated With Uc Exacerbation During The State Of Emergency. Patients With Exacerbated Cd Had Younger Age At Cd Onset And Had Higher Pro2 Scores Before The State Of Emergency Than Did Patients With Non-Exacerbated Cd. On Multivariate Analysis, Only Younger Age (Or 1.030, 95% Ci 1.010-1.05;P < 0.01) Was Independently Associated With Exacerbation During The State Of Emergency. Conclusions: We Have Showed Data On The Association Between Ibd Activity And Lifestyle Changes / Psychological Stress Due To The State Of Emergency During The Covid-19 Pandemic. This Study Suggests That Improving Sleep Quality And Preventing Psychological Stress Might Be Key In Ibd Management During The Pandemic, Especially In Young Patients. (Figure Presented) (Figure Presented) (Figure Presented) (Figure Presented)