lithium

Side Effects of Lithium and Nursing Care

Side Effects of Lithium

  • Abdominal discomfort

    • Symptoms include nausea, soft stools, and diarrhea.

  • Edema

    • Specifically affects the feet.

  • Hair Loss

    • Can lead to hypothyroidism.

  • Muscle Weakness and Fatigue

    • Commonly reported by patients.

  • Polyuria

    • May progress to diabetes insipidus.

  • Thirst

    • Increased desire to drink fluids.

  • Tremors

    • Observable shaking in hands or other areas.

  • Weight Gain

    • Notable increase in body weight.

Nursing Care for Lithium Side Effects

  • Monitoring Side Effects

    • Nurses should monitor for signs and symptoms of toxicity. If side effects persist, it's crucial to evaluate the client's response during treatment.

  • Administration Recommendations

    • Administer lithium with food or milk to minimize gastrointestinal side effects. Reassure clients that signs and symptoms may be temporary.
    • Check with the physician regarding salt restriction.

  • Thyroid Function Tests

    • Obtain thyroid function tests. If hypothyroidism continues, notify the physician, who may discontinue the drug.

  • Managing Muscle Weakness

    • Provide reassurance to the client, and adjust the dosing schedule to more frequent divided doses as per physician's order.

  • Polyuria Management

    • Increased urine output is expected; nurses should monitor intake and output, and report if urine output exceeds 3000 mL/24 hr.

  • Coping with Thirst

    • Encourage the client to stay hydrated while maintaining a stable fluid intake to prevent fluctuations in sodium levels.

  • Managing Tremors

    • Eliminate caffeine from the client’s diet, and consider switching to a slow-release form of lithium per physician's orders.

  • Addressing Weight Gain

    • Reassure clients that weight gain is common with lithium therapy. Moderately restrict caloric intake, but advise against fluid or salt restrictions.

Signs and Symptoms of Lithium Toxicity

Mild Toxicity

  • Blood Serum Fluid Levels: 1.5 mEq/L
    • Signs and Symptoms:
    • Apathy
    • Sluggishness
    • Drowsiness
    • Lethargy
    • Diminished concentration
    • Mild incoordination
    • Muscle weakness
    • Muscle twitches
    • Coarse hand tremors

Moderate Toxicity

  • Blood Serum Fluid Levels: 1.5 - 2.5 mEq/L
    • Signs and Symptoms:
    • Nausea
    • Vomiting
    • Severe diarrhea
    • Slurred speech
    • Blurred vision
    • Tinnitus
    • Apathy
    • Drowsiness
    • Lethargy
    • Moderate sluggishness
    • Muscle weakness
    • Irregular tremors

Severe Toxicity

  • Blood Serum Fluid Levels: Above 2.5 mEq/L
    • Signs and Symptoms:
    • Nystagmus
    • Irregular muscle tremors
    • Fasciculations (twitches of single-muscle groups)
    • Hyperactive deep tendon reflexes
    • Oliguria (decreased urine output)
    • Severe changes in consciousness level
    • Hallucinations
    • Grand mal seizures
    • Coma
    • Death