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Mood Stabilizers Cheat Sheet by

Lithium Carbonate Mood stabilizers


Lithium Carbonate


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


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.


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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