Personality and Mood Disorders Q 50
A client on Lithium has diarrhea and vomiting. What should the nurse do first:
A. Recognize this as a drug interaction.
B. Give the client Cogentin.
C. Reassure the client that these are common side effects of lithium therapy.
D. Hold the next dose and obtain an order for a stat serum lithium level.
Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithium level.
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld, and a test is done to validate the observation. All patients with toxicity signs and symptoms, even those with normal serum lithium levels, should be admitted for monitoring in the hospital. In case of moderate or severe symptoms, the patient has to be admitted to an intensive care unit.
Option A: The manifestations are not due to drug interaction. Lithium toxicity signs are obvious and can be identified and managed easily; however, ignoring it can be fatal. Indeed, in some cases, lithium toxicity can lead to coma, brain damage, or even death. Moreover, lithium can induce serotonin syndrome, a potentially fatal and life-threatening condition.
Option B: Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics. It is useful for drug-induced extrapyramidal symptoms and the prevention of dystonic reactions and acute treatment of dystonic reactions. Furthermore, benztropine has further off-label use as it can treat chronic sialorrhea occurring in developmentally-disabled patients.
Option C: The common side effects of Lithium are fine hand tremors, nausea, polyuria, and polydipsia. Confusion, memory problems, new or worsening tremor, hyperreflexia, clonus, slurred speech, ataxia, stupor, delirium, coma, and seizures (rarely). These effects are theoretically due to excess action on the same sites that mediate therapeutic action.