Lithium

Therapeutic range

0.4-1mmol/L

Monitoring

Lithium blood level should 'normally' be checked every 3 months
Levels should be taken 12 hours post-dose
thyroid and renal function should be checked every 6 months
patients should be issued with an information booklet, alert card and record book

Adverse effects

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain

Toxicity

Precipitants of toxicity
Toxicity may be precipitated by dehydration, renal failure, diuretics (especially bendroflumethiazide), ACE inhibitors, NSAIDs and metronidazole.

'> 1.5mmol/L
Coarse tremor
Hyperreflexia
Delirium
Seizure
Coma

Lithium can be removed by haemodialysis, if treatment with IV saline is insufficient

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