Lecture Notes: Lithium as a Mood Stabilizer

Overview

• Lithium is a medication used to treat bipolar disorder.
• It has a narrow therapeutic range, leading to common side effects.
• This mnemonic uses a comedy club scene to help remember key facts about lithium.

Key Concepts

Lithium Use

• Mood Stabilizer: Primarily used for the treatment of bipolar disorder, especially the manic phase.
• Symbolism: Lithium battery represents lithium as a mood-stabilizing drug.

Therapeutic Range

• Therapeutic Range: 0.6 to 1.2 milliequivalents per liter.
• Toxicity Level: Symptoms of toxicity appear above 1.5 milliequivalents per liter.

Side Effects and Toxicity

• Early Signs of Toxicity: Gastrointestinal distress (nausea, vomiting, diarrhea, lack of appetite).
  • Action: Do not administer the next dose; notify provider and order a serum lithium level.
• Late Signs of Toxicity: Neurological problems (confusion, ataxia, muscle tremors, seizures).
  • Action: Notify provider and get serum lithium level checked.

Risk Factors for Lithium Toxicity

• Fluid Loss: Dehydration, diuretics, severe diarrhea/vomiting can concentrate lithium levels.
  • Mnemonic: Empty water bottle symbolizes dehydration.
• Low Sodium Levels: Hyponatremia leads to fluid loss influencing lithium concentration.
  • Mnemonic: Empty salt shaker for low sodium (hyponatremia).
• Decreased Kidney Function: Impairs lithium excretion, increasing toxicity risk.
  • Mnemonic: Falling jelly beans symbolize kidney function.
• Other Medications: NSAIDs and thiazide diuretics increase toxicity risk.
  • Mnemonic: "NSAID sled" and "thigh-high boots" symbolize NSAIDs and thiazide diuretics respectively.

Special Considerations

• Pregnancy: Lithium is teratogenic, posing a risk to the fetus.
  • Mnemonic: A tarantula symbolizes teratogenic effects.

Summary

• Lithium stabilizes mood in bipolar disorder but comes with a high risk of side effects due to its narrow therapeutic range.
• Toxicity is a major concern, exacerbated by dehydration, low sodium, impaired kidney function, and certain medications.
• Early and late signs of toxicity involve gastrointestinal and neurological symptoms, respectively.
• Teratogenic risks require careful consideration in pregnancy.

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