Lithium Flashcards
Initial labs (9)
Creatine
BUN
GFR
Serum electrolytes
CBC with WBC differential
Serum hCG
UA
Baseline EKG
Lithium level
How often to to check lithium
12 hour post dose
After 4 days on medications
Every 4-5 days during initial trial
How often to check labs long term
Every 1-2 months to every 6-12 months
Which labs to check long term (7)
Creatine
BUN
GFR
TSH
UA
CBC
12 hour trough
When should EKG be checked 6-12 months
Patients over 50
Acute lithium level
0.8 - 1.2
Maintenance lithium level
0.6 - 1.0
Pharmacokinetics of lithium
Absorbed in the GI. Then excreted out
What organ is important in lithium levels
Kidney function
When is lithium contraindicated
Acute renal failure
Severe dehydration
Sodium depletion
When can lithium be used safely
Healthy kidney
CKD
Kidney transplants
When should we monitor and reduce lithium levels in GFR lab
< 60 mL/min
How does dehydration affect lithium
Increase
How does increase sodium affect lithium
Decrease
How does decrease sodium affect lithium
Increase
When does lithium toxicity levels begin to manifest
At 1.5 or greater
Symptoms of lithium toxicity
Mental: Lethargy , Fatigue, Confusion
Musculoskeletal: Clumsiness, Weakness, SEVERE TREMOR
GI: Cramping, Nausea, Vomiting
Vision: Blurred
Signs of lithium toxicity
Vision: Nystagmus
Muscle: Ataxia, DTR
Mental: AMS
CV: Arrhythmia
Medications that increase lithium
Blood pressure: ACE, ARB, Potassium sparing/Thiazide diuretics
Pain management: NSAIDs
ABX: Flagyl
Medication that can Decrease lithium levels
Theophylline
Side effects of lithium
Neuro: hand tremor
General : weight gain
Renal : polydipsia or polyuria
Elevate TSH
What type of therapeutic index does lithium have
A narrow one
[That means therapeutic levels are close to toxicity]
Polyuria
Large volume of pee
Polydipsia
Very thirsty
How does lithium affect Suicidal ideation
Highest reduction for it
