Lithium Toxicity
Features
Acute: gastrointestinal findings - nausea, vomiting, diarrhea; neurologic findings occur later Features
Chronic: neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor)
Prevention
- Avoid sodium depletion; low sodium intake precipitates lithium toxicity Prevention
- Eat regular diet & drink adequate fluids (2-3 L/day)
- Therapeutic level is 0.6-1.2 mEq/L (0.6-1.2 mmol/L)
- Level >1.5 mEq/L (1.5 mmol/L) is considered toxic
Lithium carbonate is a mood stabilizer used for the treatment of bipolar disorder. Lithium levels take some time to reach therapeutic levels, often up to a few weeks (Option 4). Clients will need to have their lithium levels carefully monitored when starting therapy, as the therapeutic range is narrow (0.6-1.2 mEq/L [0.6-1.2mmol/L]). Blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. If sodium intake is limited or the body is depleted of its normal sodium (eg, excessive perspiration, vomiting, diarrhea), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity (Option 3). Therefore, clients on lithium must consume adequate sodium in the diet. Care should be taken to avoid dehydration, so diuretic medications and substances with a diuretic effect (eg, coffee, cola, tea, alcoholic beverages) must be limited or avoided, and clients are advised to drink 2-3 liters of water each day (Options 1 and 2).
Lithium Toxicity
Features
Acute: gastrointestinal findings - nausea, vomiting, diarrhea; neurologic findings occur later Features
Chronic: neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor)
Prevention
- Avoid sodium depletion; low sodium intake precipitates lithium toxicity Prevention
- Eat regular diet & drink adequate fluids (2-3 L/day)
- Therapeutic level is 0.6-1.2 mEq/L (0.6-1.2 mmol/L)
- Level >1.5 mEq/L (1.5 mmol/L) is considered toxic
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