• 대한약리학회지
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• 제15권1_2호
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• pp.21-27
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• 1979

It is well known that picrotoxin, an amaroid substance of Anamirta cocculus, is a classic stimulant on the central nervous system accompanying convulsive activity, and it liberates catecholameine from the adrenal mdulla through its central action to increase blood sugar level. Schou reported that lithium and alcohol have the similar inhibitory property on the $Na^+,\;K^+$-ATPase activity, and recently, the therapeutic efficacies of lithium on the alcohol withdrawal syndrome and the chronic alcoholics have been studied. Many studies about the hypoglycemic effect of lithium and alcohol were reported but the interaction between those hypoglycemic action is little known. Therefore, in this paper, the hypoglycemic effect of lithium and ethanol on the hyperglycemia induced with picrotoxin, and the interaction of them in those hypoglycemic action were investigated with reference to the anticonvulsive action of them. The results were obtained as follows: 1. The convulsive dose (: $CD__{50}$) of picrotoxin in mice was slightly increased by the pretreatment of lithium or ethanol. 2. The blood sugar level was markedly increased by picrotoxin but the level was sugar level was significantly decreased by lithium, ethanol or both. 3. The hyperglycemic effect of picrotoxin was significantly potentiated by the lithium pretreatment, but the potentiation effect of lithium was markedly suppressed by the additional injection of ethanol after lithium injection and more markedly suppressed by the premedication of ethanol before lithium injection 4. The hyperglycemic effect of picrotoxin was markedly inhibited by the ethanol pretreatment, and the inhibitory effect of ethanol was significantly strenthened by the additional injection of lithium after ethanol injection, but on the contrary, the inhibitory effect was completely disappeared by the premedication of lithium before ethanol injection.

• 대한임상독성학회지
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• 제11권1호
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• pp.28-30
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• 2013

A 66-year-old male with chronic alcoholism presented with tremor, gait disturbance, memory impairment, insomnia, decreased appetite, and confusion. The patient had been taking lithium daily for treatment of bipolar disorder. Brain CT showed no specific abnormality, and serum lithium and ammonia levels were 3.63 mEq/L (therapeutic range, 0.6~1.2 mEq/L) and $85{\mu}g/dL$ (reference range: $19{\sim}54{\mu}g/dL$), respectively. Therefore, the initial differential diagnosis included chronic lithium intoxication, hepatic encephalopathy, Wernicke encephalopathy, or alcohol withdrawal syndrome. Even with the provision of adequate hydration, the patient's neurologic status did not show improvement, so that lactulose enema, thiamine replacement, and continuous venovenous hemodiafiltration (CVVHDF) were started on the third admission day. By the fifth admission day he had made a rapid neurologic recovery, and was discharged on the 20th admission day. Therefore, CVVHDF might be a treatment for patients with chronic lithium intoxication, because, even if serum lithium concentration is normal, lithium concentration in the brain may be different from that of the serum.

• 정신신체의학
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• 제16권2호
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• pp.69-74
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• 2008

섬망은 의식의 장애와 인지 증상이 급성 발병을 하며 변동하는 경과를 보여주는 기질적인 정신과 증후군이다. 임상적 아형을 이상적으로 분류하기 위한 도구는 없지만 Lipowski(1983)가 섬망의 아형을 정신운동의 활동성을 기준으로 과활동성, 저활동성, 혼재성으로 분류한 이래로 연구자들 마다 다양한 도구를 이용하여 섬망의 아형을 임상적으로 구분하여 왔다. 그 연구 결과에 의하면 저활동성 섬망의 유병율이 과활동성 섬망에 비하여 오히려 많거나 적지 않은 것으로 보고되고 있지만 증상의 특성 때문에 저활동성 섬망의 임상적 진단이 적게 이루어지거나 우울증이나 치매 등으로 오인되는 경향을 보였다. 과활동성 섬망은 알코올 또는 벤조디아제핀 금단등에 의해 유발되며 도파민 과잉과 아세틸콜린의 결핍과 관련이 있으며 고역가 항정신병약물에 반응이 좋아 다른 아형에 비하여 예후가 양호한 반면에 저활동성 섬망은 대사성 뇌병증에 의한 경우가 흔하며 고역가 항정신병약물에 의한 반응이 예상보다 좋지 않는 경우가 있으며 임상적으로 정신자극제 치료가 효과적이라는 보고가 되고 있다. 입원 기간도 더 길고 인지 증상도 심하여 전반적으로 예후가 좋지 못한 경향이 있다. 섬망은 아형을 갖는 이질적인 증후군이다. 아형이 존재한다는 것은 아마도 각기 다른 기전에 의할 가능성을 시사하며 따라서 아형에 따라 구별되는 치료 전략이 필요할 것이다.