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一名49岁门女因轻度高血压和狂燥症服用可乐啶和碳酸锂达2年。后以雷诺普利代替可乐啶,3周后出现锂中毒。雷诺普利为ACE抑制剂,能降低血管紧张素Ⅱ和醛固酮的生成,引起丟钠和失水。病人服雷诺普利1周即有腹泻,推测是锂或雷诺普利血浓增加引起,也有可能仅是腹泻导致锂浓度升高。血浆体积减少使肾小球滤过率减少,加之锂和钠离子在肾小管近端竞争性重吸收,以致锂潴留。这两种药物相互作用至锂中毒过程为10d～20d,锂浓度高达基线的2～4倍。临床医生应当注意这一潜在的、严重的药物相互作用,选用合适抗狂躁病和抗高血压药,特别是对年老、充血性心力衰
A 49-year-old woman takes cocaine and lithium carbonate for 2 years because of mild hypertension and madness. After the replacement of cocaine with rennapril, three weeks after lithium poisoning. Renopril is an ACE inhibitor that reduces the production of angiotensin II and aldosterone, causing sodium loss and dehydration. Patient taking renofibril for 1 week had diarrhea, presumably due to the increase of blood concentration of lithium or renopril, and it is also possible that only diarrhea caused the increase of lithium concentration. Reduced plasma volume to reduce glomerular filtration rate, combined with lithium and sodium ions in the proximal proximal tubular reabsorption, resulting in lithium retention. The two drugs interact to lithium poisoning process for 10d ~ 20d, lithium concentration as high as 2 to 4 times the baseline. Clinicians should pay attention to this potential, serious drug interaction, use appropriate anti-manic and anti-hypertensive drugs, especially for elderly, congestive heart failure