Purpose
Lithium produces neurochemical changes in the brain, including serotonin receptor blockade. |
There is evidence that the use of lithium can show a decrease in neuronal atrophy and/or an increase of neuronal growth |
Therapeutic Uses
Lithium is used in the treatment of bipolar disorders |
Lithium controls episodes of acute mania, and helps prevent the return of mania or depression |
Contraindications/ Precautions
Lithium is pregnancy risk category D. This medication is teratogenic, especially during the first trimester |
Discourage clients from breastfeeding if lithium therapy is necessary |
Use cautiously in clients who have renal dysfunctions, heart disease, sodium depletion, or dehydration |
Use cautiously in older adult clients and clients who have thyroid disease, seizure disorders, or diabetes |
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Complications
Complication |
Nursing Action and Education |
GI distress: nausea, diarrhea, abdominal pain |
Administer medication with meals or milk. Effects are usually transient |
Fine hand tremors: can interfere with purposeful motor skills and can be exacerbated by factors (stress, caffeine) |
Administer beta-adrenergic blocking agents (propranolol). Adjust to the lowest dosage possible, given in divided doses, or use long term acting formulas. Report an increase in tremors |
Polyuria, Mild Thirst |
Use potassium sparing diuretic (spironolactone). Maintain adequate fluid intake by consuming 1,500 to 3,000 mL of fluid from beverages and food sources. |
Weight gain |
Assist client to follow a healthy diet and regular exercise regimen |
Renal toxicity |
Monitor I&O. Adjust dosage, and keep dose low. Assess baseline kidney function, and monitor kidney function periodically. |
Goiter and hypothyroidism: with long term treatment |
Obtain baseline T3, T4, and TSH levels prior to starting treatment, then annually. Administer levothyroxine to manage hypothyroid effects. Monitor for manifestations of hypothyroidism (cold, dry skin, decreased HR, weight gain) |
Bradydysrhythmia, hypotension, and electrolyte imbalances |
Maintain adequate fluid and sodium intake. |
Lithium toxicity: common adverse effect |
Notify the provider if any nausea, vomiting, diarrhea, mental confusion and slurred speech. |
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Interactions
Interaction |
Nursing Action and Education |
Diuretics: sodium is excreted with the use of diuretics, Reduced blood sodium decreases lithium excretion, with can lead to toxicity |
Monitor for indications of toxicity and notify to provider. Maintain a diet adequate in sodium, and drink 1.5 to 3L of water each day from food or beverage sources. |
NSAIDs (Ibuprofen and Celecoxib): Concurrent use will increase renal reabsorption of lithium leading to toxicity |
Avoid use of NSAIDs. Use aspirin as a mild analgesic |
Anticholinergics: antihistamines and tricyclic antidepressants can induce urinary retention and polyuria, leading to abdominal discomfort |
Avoid medications with anticholinergic effects |
Nursing Administration
Monitor plasma lithium levels during treatment |
Obtain lithium levels with each dosage change. Once therapeutic level is obtained, monitor monthly. Older clients require more frequent monitoring. Maintain range between 0.6-1.2 mEq/L |
Severe toxicity |
provide supportive measures. Hemodialysis may be indicated. Monitor labs. Take with food to minimize GI distress. Emphasize high risk of toxicity. Provide nutritional counseling. Stress the importance of sodium and fluid intake. |
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