Alzheimer’s Delirium and Dementia Q 40
Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
A. Polyuria
B. Seizures
C. Constipation
D. Sexual dysfunction
Correct Answer: A. Polyuria
Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Before starting treatment with lithium, it is essential to get kidney function tests and thyroid function tests. Lithium is not recommended in patients with renal impairment. It is also not recommended in patients with cardiovascular disease. Avoid all diuretics. If the patient has severe renal dysfunction or failure, or severely altered mental status, then start with hemodialysis.
Option B: Rarely, toxicity can cause pseudotumor cerebri and seizures. Lithium toxicity has no antidote. Treatment for lithium toxicity is primarily hydration and to stop the drug. Give hydration with normal saline, which will also enhance lithium excretion. 20 to 30 mg of propranolol given 2 to 3 times per day may help reduce tremors.
Option C: It is also important to monitor patients for dehydration and lower the dose when there are signs of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than 2 mEq/L. Monitoring should be done every 1 to 2 weeks until reaching the desired therapeutic levels. Then, check lithium levels every 2 to 3 months for six months.
Option D: Lithium has a very narrow therapeutic index, and toxic levels are when the drug is above 2 mEq/L, which is very close to its therapeutic range. Lithium toxicity can cause interstitial nephritis, arrhythmia, sick sinus syndrome, hypotension, T wave abnormalities, and bradycardia.