Professional Documents
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Lithium
Lithium
Pre-lithium work-up
- Baseline investigations of renal function
- ECG
- Thyroid function tests
o ‘Because lithium is eliminated by the kidneys, it is important to check how
well the kidneys are working by performing a renal function test before
starting any lithium therapy.’
o ‘Because lithium can interfere with thyroid function, we like to check the
thyroid before we start treatment, and then 6-monthly thereafter. We also
take a tracing of the heart to confirm that there are no pre-existing
abnormalities that may worsens with lithium treatment.’
- A concentration of 0.5-1.0mmol/L is usually sufficient for clinical effect.
- Because the dose has to be kept within certain limits, the blood has to be monitored
initially after 5 – 7 days, and then weekly until the correct level has been reached.
Finally, levels should be monitored every 3 – 6 months when stabilisation has
occurred
- Lithium is prescribed as a single dose at night
Side effects
- Tremor
- Polyuria
- Weight gain
- Nausea
- Tremor can sometimes be treated with a beta-blocker
- Nausea can be counteracted by taking the lithium with food; sometimes, changing
the preparation of lithium can make a difference
- Mention interactions with other drugs, e.g. diuretics, NSAIDs, haloperidol
Main side effects
- Early side effects of lithium are dose-related and include GI side effects (nausea,
vomiting and diarrhoea)
- Tremor (may manifest as intention tremor)
- Dry mouth
- Later side effects that are amenable to lab measurement are more numerous and
appear at higher plasma concentrations
o Check TFTs (hypothyroidism)
o Calcium, PTH – both increased (hyperparathyroidism)
o U&E (Nephrogenic diabetes insipidus)
o U&E, urine osmolality, urine sodium (Raised levels of ADH, Hypokalaemia –
arrhythmias)
o FBC (Leucocytosis, Thrombocytosis)
o Calcium (Hypercalcaemia – arrhythmias)
o eGFR, U&E, urinalysis (Nephropathy, renal failure)
o Autoantibody screen (SLE)
o Acetylcholine receptor antibodies, Tensilon test (Myasthenia gravis)
What are the signs of toxicity and how do these relate to plasma levels?
- Severe toxicity may occur at levels > 1.5mmol/L and death may occur at higher levels
(>2.0mmol/L), although toxicity has also been reported at only midly elevated serum
concentrations
- Lithium has a narrow therapeutic index and has a number of important adverse
effects in overdose, which may be fatal’ these include neurological effects (tremor,
ataxia, nystagmus, convulsions, confusion, slurred speech and coma) as well as renal
impairment