1. Lithium

what is lithium carbonate used for?

• bipolar disorder

• acute mania

• prevention of relapse of mania or depression

• decreasing suicide risk

why does sodium intake matter with lithium?

when sodium goes down, lithium is retained and toxicity risk goes up

what is the goal for sodium intake while taking lithium?

keep sodium intake adequate and consistent, not too much and not too little

what are the main complications of lithium?

• gastrointestinal distress

• fine hand tremors

• polyuria

• mild thirst

• weight gain

• renal toxicity

• goiter and hypothyroidism

• hypotension

• electrolyte imbalance

what can help with gastrointestinal distress from lithium?

taking it with meals or milk may help

what teaching helps with lithium-related weight gain?

encourage exercise and a healthy diet

what labs should be taken before starting lithium?

thyroid levels

what tremor finding is usually expected with lithium?

fine hand tremors

what tremor finding is more concerning?

coarse hand tremors (suggests toxicity)

what is the normal therapeutic range for lithium? ***

0.6 to 1.2 mEq/L

what common adverse effects can happen when lithium is below 1.5 mEq/L?

• diarrhea, nausea, vomiting

• thirst, polyuria

• fine hand tremors

• slurred speech, lethargy

what should be taught about common lithium adverse effects below 1.5 mEq/L?

these effects often improve over time

what findings suggest mild lithium toxicity at 1.5 to 2.0 mEq/L?

• mental confusion, sedation

• poor coordination

• coarse tremors

• ongoing GI distress

what should be done for mild lithium toxicity? (1.5-2.0)

• withhold the medication

• notify the provider

• expect the dosage to be adjusted based on lithium and sodium levels

what findings suggest moderate lithium toxicity at 2.0 to 2.5 mEq/L?

• polyuria

• tinnitus

• giddiness

• seizures

• ataxia

• hypotension

• stupor that can lead to coma

• respiratory complications that can lead to death

what treatment can be used for moderate lithium toxicity?

• an emetic or gastric lavage

• a diuretic to promote excretion

what happens in severe lithium toxicity above 2.5 mEq/L?

manifestations can progress rapidly to coma and death

• hold and notify provider ASAP

what treatment is used for severe lithium toxicity? (2.5+)

hemodialysis

what teaching helps prevent lithium toxicity?

• drink 2 to 3 liters of fluid daily

• keep salt intake adequate

• know that renal disease makes lithium a poor fit

how much fluid should a client taking lithium drink each day?

2 to 3 liters daily

what should a client know about salt intake while taking lithium?

keep salt intake adequate and consistent, because low sodium can cause lithium retention and toxicity

why is renal disease a concern with lithium?

lithium is a poor fit in renal disease because it raises the risk of toxicity

• anticonvulsants given instead