A client taking lithium for bipolar disorder has had vomiting and severe diarrhea for 2 days and is now tremulous, drowsy, and unsteady. The morning lithium dose is due. Complete the priority plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Prolonged vomiting and diarrhea can cause sodium and volume depletion, reduce lithium clearance, and precipitate toxicity. Tremor, drowsiness, and unsteady gait are neurologic warning signs. Hold lithium and notify the provider or rapid-response pathway; do not wait for a serum concentration before acting on toxicity cues. Anticipate a timed serum lithium concentration, electrolytes, blood urea nitrogen, creatinine, and an ECG, together with repeated neurologic and cardiac assessment. Prescribed isotonic fluid replacement is commonly required when volume depletion is present, while the team evaluates severity and the need for poison-control, toxicology, or nephrology consultation.
Correct Answer Hold lithium, escalate urgently, obtain a lithium concentration with renal and electrolyte studies, and begin monitored supportive care with prescribed isotonic fluid replacement when appropriate.
Why It Fits Diarrhea and vomiting cause sodium and volume loss. The kidneys then retain more lithium, and neurologic findings such as tremor, drowsiness, and ataxia signal possible toxicity even before a laboratory result returns.
Clinical Picture Lithium travels with body water and sodium balance. When fluid and sodium are lost, the lithium concentration can rise and the brain becomes an early warning system.
Memory Link Lithium plus GI loss plus neurologic change: hold, hydrate as ordered, check level and kidneys, monitor.
NCLEX Rule Act on clinical toxicity cues rather than administering the scheduled dose and waiting for the next visit. A lithium concentration supports the diagnosis but does not replace immediate safety actions.
Why the Alternatives Fail Giving another dose can worsen toxicity. An antidiarrheal alone does not correct lithium accumulation or dehydration. A normal past lithium level does not rule out new toxicity after acute fluid loss.
Source
1FDA Prescribing Information: Lithium and Lithium Carbonate
The client has reduced oral intake and signs of volume depletion. No additional lithium has been given today, and urgent laboratory testing and monitored treatment are available.
Lithium — A mood stabilizer with a narrow therapeutic range requiring monitoring for toxicity.
Bipolar Disorder — A mood disorder characterized by episodes of mania or hypomania and often depression.
Serum Drug Level — A blood measurement used to evaluate whether a medication concentration is therapeutic or toxic.