# 一名因雙相情緒障礙服用鋰的個案表示已嘔吐與腹瀉2天，且因背痛開始服用 ibuprofen。護理師發現粗大手抖與步態不穩。護理師首先應採取哪項行動？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375323&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名因雙相情緒障礙服用鋰的個案表示已嘔吐與腹瀉2天，且因背痛開始服用 ibuprofen。護理師發現粗大手抖與步態不穩。護理師首先應採取哪項行動？

## 選項

1. 提早給予下一次的 lithium 劑量以預防急性情緒復發；鼓勵口服液體補充水分。
2. 教導個案於用餐時服用 lithium 以減少噁心，並於下次回診時重新檢測 lithium 濃度。
3. 暫停鋰並通知開立處方者；預期檢測血清鋰、BMP、補液與毒性評估。 **✔ 正確答案**
4. 建議低鈉飲食以減少 lithium 相關的體液滯留；監測每日體重及水腫。

**正確答案: 3**

## 解析

嘔吐、腹瀉、脫水、NSAID使用、粗大顫抖與共濟失調都是 鋰中毒 的警訊。NSAID可能降低腎臟鋰清除率。優先處置是暫停藥物、通知處方者、檢查鋰濃度與腎臟/電解質數值，並矯正脫水。

## 深入解析

注意 鋰在腎臟中的處理方式類似鈉。脫水、鈉耗竭、NSAID、ACE抑制劑、ARB與thiazide都可能升高鋰濃度。

## 臨床情境

情境 鋰 + 腸胃道體液流失 + ibuprofen + 粗大顫抖/共濟失調。

## 重要概念

- **鋰中毒** — 早期毒性包括腸胃不適與細微顫抖；惡化時可出現粗大顫抖、意識混亂、共濟失調、構音困難與癲癇。
- **NSAID交互作用** — NSAID會降低腎灌流/前列腺素，可能減少鋰清除率並增加毒性風險。
- **水分與鈉** — 穩定的水分與鈉攝取有助於避免鋰濃度大幅波動；低鈉飲食會增加鋰再吸收。

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