Bipolar Medications - Lithium

Bipolar Meds: Lithium

Drug Name

• Lithium

Indications

• Treatment for:

  • Bipolar Disorder

  • Schizoaffective Disorder

Therapeutic Levels

• Therapeutic Level:

  • Between 0.5 and 1.5 mEq/L

• Levels over 1.5 mEq/L:

  • Considered toxic!

Common Test Question

• Is the lithium at a therapeutic level?

  • Yes: Continue at the current dose.

  • Recommendations:

  • Increase fluid intake.

  • Ensure sufficient sodium (Na+) intake.

Contraindications

• Dehydration

• Low Sodium

  • Hyponatremia defined as below 135 mEq/L

• Recommendation: Do not limit sodium or water intake.

High Risk of Toxicity

• Conditions leading to toxicity:

  • Stomach flu, resulting in diarrhea and vomiting.

  • Signs to report to healthcare provider (HCP) if toxicity is suspected:

  • Excessive urination

  • Extreme thirst

  • Vomiting and diarrhea

  • Neuro muscular excitability (tremors / myoclonic jerks)

Memory Trick

• Mnemonic: "Lithium + T = Toxic Signs"

• Key signs to report:

  • Excessive urination

  • Extreme thirst

  • Vomiting

  • Diarrhea

  • Neuro muscular excitability

Key Points on Toxicity

• Toxicity Level: Levels over 1.5 mEq/L

Kidney Indicators of Toxicity

• Creatinine Level:

  • Over 1.3 is indicative of bad kidney function.

• Urine Output:

  • 30 ml/hour or less indicates kidney distress.

• Additional Symptoms:

  • Tinnitus (ringing of the ears)

Medication Considerations

• HOLD NSAIDs (e.g., Ibuprofen, Naproxen):

  • Reason:

  • NSAIDs decrease renal blood flow, which may increase risk of toxicity.

• Recommendation: Patient education is essential; avoid NSAIDs and ensure adequate communication about the risks of toxicity.