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.
一名46歲患有雙相情感障礙I型的成年個案，每天兩次服用600毫克碳酸鋰，並服用氫氯噻嗪治療高血壓。個案已嘔吐和腹瀉3天，期間持續服用鋰鹽，並每6小時使用布洛芬緩解痙攣。一名家庭成員將個案帶到急診室，因為個案出現意識混亂和步態不穩。上個月的門診記錄：情緒穩定，心率每分鐘72次且規律，手部細微顫抖已持續數年，以及多年來每晚醒來排尿2-3次。目前評估：雙手粗大顫抖，伸手時更嚴重；言語含糊不清；步態寬基且向一側搖晃；無法說出月份或醫院名稱；否認有自傷意念；否認有思緒奔騰或睡眠減少。血壓98/62毫米汞柱，心率每分鐘54次且不規則，呼吸頻率每分鐘18次，體溫37.6 C (99.7 F)，室內空氣下血氧飽和度98%。黏膜乾燥。微血管血糖104 mg/dL。家屬報告10天前在婚禮上最後一次飲酒。血清鋰濃度和代謝檢查結果待定。