Vomiting, coarse tremor, confusion, and ataxia are concerning for lithium toxicity. NSAIDs can reduce renal lithium clearance and increase serum concentrations. The nurse should hold lithium, notify the prescriber urgently, and anticipate serum lithium, electrolytes, renal-function testing, hydration assessment, and supportive treatment. Additional lithium, sodium or fluid restriction, and delayed follow-up can worsen toxicity and injury risk.
In-depth explanation
Clinical reasoning
Lithium is cleared by the kidneys. NSAID-related changes in renal perfusion can reduce lithium clearance, while vomiting adds dehydration and sodium-loss risk.
Decision rule
New gastrointestinal and neurologic findings during lithium therapy require the drug to be held and urgent toxicity evaluation, including renal function and a properly timed serum lithium concentration.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.