# 一名雙相情緒障礙病人服用碳酸鋰600 mg口服每日三次已3週。回診時報告新出現的症狀。何項最令人擔憂且需立即通知醫師? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw > language: zh-TW > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## 題目 一名雙相情緒障礙病人服用碳酸鋰600 mg口服每日三次已3週。回診時報告新出現的症狀。何項最令人擔憂且需立即通知醫師? ## 選項 1. 起床時細微的手部顫抖 2. 兩週體重增加1 kg 3. 粗大手部顫抖、口齒不清、共濟失調 **✔ 正確答案** 4. 口渴與排尿增加 **正確答案: 3** ## 解析 鋰治療範圍狹窄(0.6~1.2 mEq/L)。粗大顫抖、構音障礙(口齒不清)與共濟失調代表中重度毒性(>1.5 mEq/L),需立即暫停給藥、抽血測鋰濃度並通知醫師。多渴多尿、起床細微顫抖、輕度體重增加為治療濃度下常見副作用。 ## 深入解析 臨床判斷 鋰中毒分級: 輕度1.5-2.0(粗大顫抖、腸胃症狀)、中度2.0-2.5(共濟失調、構音障礙、混亂)、重度>2.5(癲癇、昏迷)。共濟失調+構音障礙+粗大顫抖=中度以上毒性。 記憶口訣 鋰中毒ABCD: Ataxia, Blurred speech, Coarse tremor, Diarrhea 韓 vs 美 治療範圍與毒性標準臺美一致。臺灣精神科亦每季抽鋰濃度,腎功能與甲狀腺每6個月。 ## 臨床情境 臨床指引 APA雙相情緒障礙指引將鋰列為維持治療與急性躁狂之第一線。治療範圍: 0.6-1.2 mEq/L(急性躁狂可至1.5)。毒性分級: 輕度1.5-2.0、中度2.0-2.5、重度>2.5。濃度>4或>2.5伴症狀需血液透析。 注意 脫水、低鹽飲食、NSAID、ACE抑制劑、thiazide利尿劑會提高鋰濃度。維持穩定水分與鹽分攝取,使用成藥NSAID前先諮詢。 ## 重要概念 - **碳酸鋰** — 雙相情緒障礙第一線情緒穩定劑。治療範圍狹窄0.6~1.2 mEq/L。經腎臟原型排出;每3-6個月評估腎功能與血清濃度。預期脫水之手術前需暫停。 - **鋰中毒** — 輕度(1.5-2.0): 粗大顫抖、腸胃不適、多尿。中度(2.0-2.5): 共濟失調、構音障礙、混亂、肌肉抽搐。重度(>2.5): 癲癇、昏迷、心血管崩潰。重度需血液透析。 - **狹窄治療指數** — 毒性劑量接近治療劑量的藥物。例: 鋰、warfarin、digoxin、theophylline、phenytoin、vancomycin。需定期血中濃度監測及病人症狀辨識教育。 ## 相同主題題目 - [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=zh-tw) - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw) - [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=zh-tw) - [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=zh-tw) - [A 62-year-old patient is being discharged after a deep vein thrombosis and will continue e…](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_