腹腔鏡下スリーブ状胃切除術後リチウム中毒をきたした1例

A case of lithium toxicity after laparoscopic sleeve gastrectomy

◆要旨：適応障害に対して他院精神科に通院し，炭酸リチウムを含む内服治療をしていた高度肥満症の女性に対して，腹腔鏡下スリーブ状胃切除術後，リチウム中毒をきたした症例を経験した．退院1週間後，全身倦怠感，振戦などの中枢神経症状，悪心・嘔吐などの消化器症状で発症し，再入院となった．リチウム血中濃度の上昇（3.8mEq/l）を認め，リチウム中毒と診断した．精神科主治医と連携し，炭酸リチウムの内服を中止し，数日後にリチウム血中濃度は低下し症状も軽快した．腹腔鏡下スリーブ状胃切除術の術後は，十分な水分摂取量を確認後に退院を許可しているが，本症例は退院後水分摂取が十分ではなく，脱水状態がリチウム血中濃度を上昇させたと考えられた．

　A morbidly obese woman who went to psychiatric clinic at another hospital for adjustment disorders and took oral medicine containing lithium carbonate, experienced lithium toxicity after undergoing laparoscopic sleeve gastrectomy. One week after discharge from the hospital, she developed central nervous system symptoms such as general malaise and tremor, and digestive symptoms such as nausea and vomiting, and was re-hospitalized. An increase in serum lithium concentration（3.8mEq/l）was observed and she was diagnosed as lithium toxicity. In cooperation with the psychiatrist at another hospital, oral administration of lithium carbonate was discontinued, and serum lithium level decreased in a few days and her symptoms improved. After laparoscopic sleeve gastrectomy, we allowed the patient to leave the hospital after confirming enough fluid intake. However, it was suggested that she did not take enough fluid after discharge, leading to dehydration and increase in serum lithium level. We report a case of lithium toxicity after laparoscopic sleeve gastrectomy. It is important to understand that lithium toxicity can occur after bariatric metabolic surgery, and to detect lithium toxicity at an early stage in cooperation with psychiatrists by monitoring serum lithium concentrations, so that patients does not become seriously ill.