A 46-year-old adult with bipolar I disorder takes lithium carbonate 600 mg twice daily and hydrochlorothiazide for hypertension. For 3 days the client has had vomiting and diarrhea, kept taking lithium, and used ibuprofen every 6 hours for cramps. A family member brings the client to the emergency department because of confusion and unsteady walking. Clinic note from last month: mood stable, HR 72/min and regular, fine hand tremor for several years, and wakes to urinate 2-3 times nightly for years. Current assessment: coarse tremor in both hands, worse on reaching; speech is slurred; walks with a wide base and lurches to the side; cannot state the month or the hospital name; denies thoughts of self-harm; denies racing thoughts or reduced sleep. BP 98/62 mm Hg, HR 54/min and irregular, RR 18/min, temperature 37.6 C (99.7 F), SpO2 98% on room air. Mucous membranes are dry. Capillary glucose 104 mg/dL. The family reports last alcohol use at a wedding 10 days ago. Serum lithium and a metabolic panel are pending.
A 46-year-old adult with bipolar I disorder takes lithium carbonate 600 mg twice daily and hydrochlorothiazide for hypertension. For 3 days the client has had vomiting and diarrhea, kept taking lithium, and used ibuprofen every 6 hours for cramps. A family member brings the client to the emergency department because of confusion and unsteady walking. Clinic note from last month: mood stable, HR 72/min and regular, fine hand tremor for several years, and wakes to urinate 2-3 times nightly for years. Current assessment: coarse tremor in both hands, worse on reaching; speech is slurred; walks with a wide base and lurches to the side; cannot state the month or the hospital name; denies thoughts of self-harm; denies racing thoughts or reduced sleep. BP 98/62 mm Hg, HR 54/min and irregular, RR 18/min, temperature 37.6 C (99.7 F), SpO2 98% on room air. Mucous membranes are dry. Capillary glucose 104 mg/dL. The family reports last alcohol use at a wedding 10 days ago. Serum lithium and a metabolic panel are pending.