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What is the therapeutic lithium range?
0.4–1.0 mmol/L depending on phase (maintenance usually lower).
When should lithium blood levels be taken?
12 hours post-dose for accurate trough measurement.
When should the first lithium level be checked after initiation?
7 days after starting.
How often should lithium levels be checked during titration?
Weekly until stable.
How often should lithium levels be checked once stable?
Every 3 months.
What other monitoring should occur every 3 months?
U&Es and TFTs.
What tests should occur every 6–12 months?
Calcium and weight/BMI.
Three key baseline tests before starting lithium?
U&Es
Which symptoms suggest early lithium toxicity?
Coarse tremor
What are severe red-flag symptoms of lithium toxicity?
Seizures
Immediate action if lithium toxicity suspected?
Stop lithium and arrange urgent hospital assessment with repeat levels
Why should patients avoid dehydration on lithium?
Low sodium or dehydration increases lithium levels → toxicity risk.
What advice should be given regarding salt and fluid intake?
Maintain consistent salt and fluid intake; avoid dehydration.
Which common OTC medicine should patients avoid and why?
NSAIDs (like ibuprofen) → increase lithium levels.
Two classes of prescription drugs that increase lithium levels?
ACE inhibitors and diuretics.
Why monitor thyroid function in lithium therapy?
Risk of lithium-induced hypothyroidism.
Why monitor renal function in lithium therapy?
Lithium is renally excreted → renal impairment increases toxicity risk.
What condition causes excessive thirst and urination in lithium use?
Nephrogenic diabetes insipidus.
Key counselling for missed doses of lithium?
Do not double up doses — contact prescriber if multiple missed.
What is a key pregnancy risk with lithium?
Risk of Ebstein’s anomaly (needs specialist MDT review).
What documentation must accompany each review?
Lithium level + timing
