Lithium

Question 1

Endocrine s/s of lithium Tx

Answer 1

hypothyroidism
weight gain

Question 2

CNS s/s lithium toxicity (6)

Answer 2

fine hand tremors
mental cloudiness
fatigue
headaches
nystagmus
course hand tremors

Question 3

GI s/s of lithium toxicity (4)

Answer 3

Diarrhea
vomiting
cramps
anorexia

Question 4

Renal s/s of lithium toxicity (5)

Answer 4

diabetes insipidus
polyuria
polydipsia (increased thirst)
edema
tubular changes

Question 5

Lithium & kidneys/ drug decrease renal clearance (3)

Answer 5

NSAIDs
thiazides
ace inhibitors
can all increase serum levels of lithium

Question 6

Normal values of lithium

Answer 6

0.6-1.2meq/L

Question 7

lithium toxicity can occur at levels of

Answer 7

1.5meq/L or higher - DC lithium

Question 8

Levels of 1.3-1.4 meq/L with signs of toxicity what do you do?

Answer 8

DC lithium

Question 9

What is the gold standard for treating manic episodes

Answer 9

lithium due to anti suicidal effects

Question 10

Labs to take for lithium (5)

Answer 10

thyroid (TSH)
serum creatinine (0.6-1.2mg/dl)
BUN (10-20mg/Dl)
Urinalysis check for proteins in urine, large amounts of protein 4+ can indicate kidney disease
Pregnancy test HCG for women 12-51 yo

Question 11

client on lithium which lab values are concerning? Creatinine 4.5 or BUN 4.5

Answer 11

both are not within normal limits BUT the concern with lithium is the RISK of toxicity
when BUN is low there is a lesser risk of lithium toxicity
so answer is creatinine

Question 12

When creatinine is high it can _____

Answer 12

reduce kidney functions therefore increasing RISK OF LITHIUM TOXICITY

Question 13

if creatinine is low 0.2 and BUN of 40 which one is more concerning

Answer 13

BUN of 40 due to potential decrease in kidney function because Creatinine is low its not as emergent

Question 14

S/E of lithium (6)

Answer 14

Hypothyroidism
fine hand tremors
maculopapular rash, GI upset
Diabetes insipidus
T wave inversions
Leukocytosis (increased WBCs)

Question 15

Client is on lithium and is stable on dose but is showing signs of hypothyroidism what do you do? and client has hx of Hashimoto’s thyroiditis in family

Answer 15

refer the client out to PCP due to family history increases risk of hypothyroidism

Question 16

Lithium can cause what in the heart

Answer 16

ebstein anomaly (congenital heart defect)

Question 17

Signs of lithium toxicity (9)

Answer 17

severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart palpitations, coarse hand tremors, unsteadiness (ataxia) while walking

Question 18

When client is already showing signs of lithium toxicity what should you do

Answer 18

DC and check serum levels

Question 19

what kind of drugs can potentially increase the serum levels of lithium? (5) by reducing renal clearance

Answer 19

Colchicine (antigout)
NSAIDs (ibuprofen, indocin)
thiazides (hydrochlorothiazide)
ACE inhibitors
lisinopril

Question 20

dehydration can do what to lithium

Answer 20

increase levels, educate client that hydration is key

Question 21

lower sodium levels (hyponatremia) can do what to lithium

Answer 21

reduce lithium clearance and increase lithium levels (increasing risk of toxicity)