A patient with bipolar I disorder on chronic lithium therapy presents to the ED after several days of vomiting and diarrhea from a viral illness. Serum lithium is 1.7 mEq/L. Which clinical findings and nursing actions are appropriate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Lithium has a narrow therapeutic window (0.6-1.2). Volume depletion from GI losses concentrates lithium and triggers toxicity. Priorities: hold the dose, notify provider, recognize coarse tremor/ataxia/slurred speech as toxicity (not therapeutic effect), rehydrate, and prepare for dialysis at severe levels (≥2.5) or progressive neuro symptoms. Choice 5 is wrong — LOW sodium causes the kidneys to reabsorb MORE lithium, raising serum levels; patients should maintain consistent sodium and water intake.
Sodium balance and lithium are linked: anything that drops sodium (low-salt diet, thiazides, vomiting, sweating) raises lithium. The single most important teaching point for chronic lithium patients is "do not change your salt or water intake suddenly" — and call the provider for any GI illness, fever, or new diuretic.
Bipolar I patient on chronic lithium presents after several days of vomiting and diarrhea from a viral illness. Serum lithium 1.7 mEq/L (therapeutic 0.6-1.2). The patient now reports coarse tremor and unsteady gait.
Lithium toxicity — Mild 1.5-2.0, moderate 2.0-2.5, severe >2.5; presents with tremor, GI symptoms, ataxia, dysarthria, confusion, seizures.
Coarse tremor — Large-amplitude tremor distinct from the fine tremor of therapeutic lithium use; signals toxicity.
Hemodialysis indication — Severe toxicity (>2.5-4.0 mEq/L), progressive neurologic findings, or renal failure preventing excretion.