Lithium

Question 1

What contraidications would you check for in someone starting on lithium?

Answer 1

• 1st trimester pregnancy
• Breast-feeding
• Cardiac-insufficiency/rhythm disorder
• Significant renal impairment
• Addison’s disease
• Low sodium
• Untreated hypothyroidism

Question 2

What is involved in treatment with lithium?

Answer 2

Once/twice daily tablet/liquid

Question 3

What investigations would you do before starting someone on lithium?

Answer 3

• FBC
• U+E’s
• LFTs
• BHCG
• ECG

Question 4

What monitoring is required for lithium?

Answer 4

• Check level after 5 days initiating treatment, then every week until stable for 4 weeks
• 3 monthly following this

Question 5

What bloods should you check every 6 months in someone who is on lithium?

Answer 5

• TFTs
• U+E’s
• Ca2+

Question 6

What are side effects of lithium therapy?

Answer 6

• GI disturbance
• Metallic taste
• Fine tremr
• Water symptoms - polyuria, polydipsia
• Renal toxicity
• Nephrogenic DI
• Hypothyroidism
• Lithium toxicity

Question 7

What are features of lithium toxicity?

Answer 7

• GI - anorexia, diarrhoea, vomiting
• Neuromuscular - dysarthria, dizziness, ataxia, impaired coordination, muscle twitching
• Drowsiness
• Apathy
• REstlessness