Lithium

Question 1

What is lithium?

Answer 1

A mood stabiliser primarily used in bipolar disorder and mania, also used in recurrent depression and for mood stabilisation in aggressive or self-harming behaviour.

Question 2

What is the primary indication for lithium?

Answer 2

Bipolar disorder, particularly mania.

Question 3

What other psychiatric indications does lithium have?

Answer 3

Recurrent depression and mood stabilisation in aggression or self-harm.

Question 4

Which endocrine disorder contraindicates lithium use?

Answer 4

Addison’s disease.

Question 5

Which cardiac conditions contraindicate lithium?

Answer 5

Cardiac disease with rhythm disorders and personal or family history of Brugada syndrome.

Question 6

Why are low-sodium diets a contraindication to lithium?

Answer 6

Low sodium increases lithium reabsorption and risk of toxicity.

Question 7

Which thyroid disorder contraindicates lithium?

Answer 7

Untreated hypothyroidism.

Question 8

Why is severe renal impairment a contraindication to lithium?

Answer 8

Reduced excretion increases the risk of lithium toxicity.

Question 9

What does the mnemonic LITHIuM stand for in lithium side effects?

Answer 9

Leucocytosis, Insipidus, Tremor (fine), Hypothyroid, Increased weight, Metallic taste.

Question 10

What renal side effect is classically associated with lithium?

Answer 10

Nephrogenic diabetes insipidus.

Question 11

What haematological change is commonly seen with lithium?

Answer 11

Leucocytosis.

Question 12

What counselling should be given to women of childbearing age on lithium?

Answer 12

Use effective contraception.

Question 13

Why is lithium generally avoided in pregnancy?

Answer 13

Risk of cardiac malformations, especially in the first trimester.

Question 14

What investigations are required before starting lithium?

Answer 14

Renal function (U&Es), ECG, thyroid function tests, BMI, and full blood count.

Question 15

Which parameters should be monitored during lithium treatment?

Answer 15

Body weight/BMI, serum electrolytes, eGFR, and thyroid function.

Question 16

How often should lithium monitoring occur during treatment?

Answer 16

Every 6 months, or more frequently if renal or thyroid function is impaired or calcium is raised.

Question 17

What features suggest a therapeutic lithium level?

Answer 17

Fine tremor, dry mouth, gastrointestinal disturbance, increased thirst, increased urination, drowsiness, and thyroid dysfunction.

Question 18

What tremor is associated with lithium toxicity?

Answer 18

Coarse tremor.

Question 19

What CNS features suggest lithium toxicity?

Answer 19

Seizures, impaired coordination, dysarthria, and confusion.

Question 20

What cardiac features may occur in lithium toxicity?

Answer 20

Cardiac arrhythmias.

Question 21

What visual symptoms may occur in lithium toxicity?

Answer 21

Visual disturbance.

Question 22

Which neurological conditions can mimic lithium toxicity?

Answer 22

Parkinson’s disease and cerebellar disorders.

Question 23

Which endocrine conditions may resemble lithium side effects?

Answer 23

Diabetes insipidus and diabetes mellitus.

Question 24

Which cardiac conditions may mimic lithium toxicity?

Answer 24

Primary cardiac arrhythmias.

Question 25

Which substance-related conditions may overlap with lithium toxicity?

Answer 25

Alcohol or benzodiazepine withdrawal and other substance intoxications.

Question 26

What is the gold-standard investigation for lithium toxicity?

Answer 26

Serum lithium level.

Question 27

Which blood tests are essential when assessing lithium toxicity?

Answer 27

Electrolytes, renal function tests, and thyroid function tests.

Question 28

Why is an ECG required in lithium toxicity?

Answer 28

To assess for cardiac arrhythmias.

Question 29

What are the key supportive measures in lithium toxicity?

Answer 29

Maintain electrolyte balance, monitor renal function, and control seizures.

Question 30

What fluid therapy is used in lithium toxicity?

Answer 30

IV fluids to enhance renal excretion.

Question 31

Which drugs are used for agitation or seizures in lithium toxicity?

Answer 31

Benzodiazepines.

Question 32

When is haemodialysis indicated in lithium toxicity?

Answer 32

If renal function is poor or toxicity is severe.

Question 33

What are the major complications of lithium therapy?

Answer 33

Severe renal impairment, CNS disturbances including seizures, and cardiac arrhythmias.

Question 34

What factors influence prognosis in lithium toxicity?

Answer 34

Renal function, serum lithium levels, and adherence to monitoring protocols.