Lithium is a medication used to treat bipolar disorder. It has a narrow therapeutic range, which means that side effects are common with this drug. In this visual mnemonic, I'll teach you an easy way to remember everything you need to know about lithium for test day. What are we waiting for?
Let's go! For today's mnemonic video, we're visiting the Pixarize Comedy Club, where we have a woman on stage getting ready for her stand-up. Unfortunately, nothing is going as planned. We'll get into the details later, but let's start with this lithium battery here. The battery has popped out of the microphone and is rolling across the stage.
This lithium battery is our symbol for, you guessed it, lithium. Lithium is a very common mood-stabilizing drug, and the NCLEX loves to test you on lithium. So when you see a question about lithium, use this lithium battery to anchor yourself back into this scene. Let's move on and learn more about lithium. Like you would expect in a comedy act, this woman has brought some props along with her.
First, notice the drama mask on her head. The dual drama mask represents both comedy and tragedy in ancient Greek theater. But here, the happy and sad side of this drama mask should also help you remember bipolar disorder, because half of the mask is happy while the other half is sad. Kind of like how people with bipolar can have mood swings between mania and depression.
Get it? Lithium is a mood stabilizer, meaning it is used to treat bipolar disorder, especially the manic phase of the disease. However, lithium has a very narrow therapeutic range, meaning that the minimum dose needed to have a therapeutic effect is very close to the dose where side effects are experienced.
As such, most patients taking the drug end up experiencing side effects. Let's talk about these next. Like many comedy shows, this one lasts an hour and a half, or 1.5 hours.
It's posted right there on the wall. 1.5 hours, see? This number, 1.5, is really important when it comes to lithium. You see, lithium toxicity usually starts to show up around 1.5 milliequivalents per liter.
Now, the actual therapeutic range for the drug is 0.6 to 1.2. But the most important number for you to remember is 1.5. Because above 1.5, the patient will start to show symptoms of toxicity, manifesting as side effects.
For patient safety, it's best to keep the blood lithium levels below 1.5. As such, patients taking lithium will require frequent blood draws to ensure that doses don't get too high. Now, there's a lot of potential things that can increase the risk of lithium toxicity.
Let's talk about these in order next. Take a look at the spectator there in the front row. Everything on his table there is going to relate to causes of lithium toxicity. This comedy theater is nice because there are tables at the seats, allowing guests to snack while they enjoy the show. This man must have been thirsty judging by that empty water bottle.
You know, this empty water bottle reminds me of fluid loss or dehydration because there's no fluid in the bottle. Get it? Fluid loss is a big risk factor in causing lithium toxicity. Examples of fluid loss include when a patient gets dehydrated, is taking a diuretic, or has severe diarrhea or vomiting. In each of these instances, the patient is losing fluid, and this fluid loss can cause lithium toxicity because losing fluid concentrates the blood, which increases the concentration of lithium in the blood.
Therefore, encourage your patients taking lithium to stay hydrated. The spectator can't believe what is happening on stage, and in his surprise, he has abruptly stood up, knocking over the empty salt shaker. This man used all the salt while snacking, leaving the salt shaker empty. This empty salt shaker is our symbol for low sodium, or hyponatremia. Remember that water likes to follow sodium, so if the patient has low sodium levels in their body, the fluid isn't very likely to stick around.
And remember what we just talked about with fluid loss? That's right, lithium toxicity. Through this method, low sodium can also cause lithium toxicity. This is a commonly tested concept because generally we encourage people to limit sodium intake.
This, however, is not the case with lithium. People taking lithium need to have an adequate sodium intake and should not drastically change how much sodium they are consuming. So don't let the NCLEX trick you on this one.
Like with the empty salt shaker, the man's jelly beans have also spilled and are tumbling onto the stage. Jelly beans make for a great snack during a show. but not after they've rolled onto the stage floor. Here at Pixerize, we use jelly beans to symbolize the kidneys, because they have the same shape, right? These falling jelly beans represent falling kidney function.
You see, the risk of lithium toxicity is also increased by impaired kidney function. Lithium is excreted through the kidneys, so when the kidneys aren't working properly, the drug builds up in the body. Makes sense, right?
Just use these falling jelly beans to help you remember that decreased kidney function can also cause lithium toxicity. Now, there are two more things that can cause lithium toxicity, and they are actually other medications. Let's talk about them next.
We mentioned earlier that the comedian brought along some props to help her act. Well, one of those props is a sled. You know, the kind you would use in the snow. This sled is getting vomited on.
More on that later. So the comedian here is going to have to improv, because there's no way this sled is going to be used as a prop now. By the way, this sled is our symbol for NSAIDs.
Get it? A sled for NSAIDs? It's the NSAID sled, or the NSAID, if you will. NSAIDs, like ibuprofen and naproxen, should not be taken with lithium, just like this sled shouldn't be used as a prop anymore.
Get it? Instead, the patient should be advised to use acetaminophen, or Tylenol, instead for pain relief. The vomit didn't just get on the sled, it also got onto the comedian's thigh-high boots. Yeah, those probably weren't the best choice of shoes to wear to a comedy show anyway. Here at Pixerize, we use thigh-high boots as our recurring symbol for thiazide diuretics.
Thigh-high for thiazide, get it? Like NSAIDs. thiazide diuretics can cause lithium toxicity and should not be taken concurrently with lithium.
Now, let's discuss how to notice lithium toxicity in the clinical setting. Back to that vomit on the sled, the comedian was so nervous about being on stage that she was feeling really queasy all the way up until she vomited right on stage. This is every performer's nightmare.
When you think of this woman vomiting, remember that GI distress is an early sign of lithium toxicity. By GI distress, I mean things like nausea, vomiting, diarrhea, and lack of appetite. This is not an expected side effect of lithium, but it is instead an early sign of lithium toxicity. If the patient is experiencing any of these GI discomforts, the nurse should not administer the next dose of lithium. Instead, the provider should be called, and you can expect to receive an order for a stat serum lithium level.
Remember, we talked earlier about how toxicity symptoms start to show up above 1.5. If you can remember, the thing that has started this whole comedy fiasco is the lithium battery popping out of the microphone. Take a closer look at that microphone and notice that there are sparking wires where the lithium battery is supposed to be attached.
At Pixerize, we like to use wires to symbolize the nervous system. You know, since nerves are what send electrical signals throughout the body, kind of like wires. Well, these nerves here are malfunctioning, the way they are sparking like that.
This is to help you remember that a late sign of lithium toxicity is neurological problems. By neurological problems, I mean things like confusion, ataxia, or impaired coordination, muscle tremors, twitching, sedation, seizures, increased urination, and so on. I would not remember this massive laundry list, but would instead categorize all of these as nerve problems that occur due to lithium toxicity.
If the patient is experiencing any of these symptoms, the provider must be notified immediately. Be sure to get a serum lithium test here, as it's pretty likely you'll see a level above 1.5. As the woman was reaching across the stage to grab the lithium battery, she came across a tarantula hiding out under the podium.
I guess tarantulas do like to hide in... dark nooks and crannies. But I didn't think the comedian was expecting to come face to face with it today. I'm sure that didn't help her nerves or her upset stomach. Anyway, this tarantula is here to symbolize the fact that lithium is teratogenic.
You know, since tarantula sounds like teratogen. It's the teratogenic tarantula. Anyway, this should help you remember that lithium is teratogenic and should not be given during pregnancy due to the risk of causing fetal birth defects. At this point, I'm not sure if the comedy show is going to continue or not, so I guess we have time to do a quick recap. Lithium is a mood-stabilizing drug used to treat bipolar disorder.
It has a narrow therapeutic range, and symptoms of toxicity start to show up above a blood level of 1.5. Things that can cause lithium toxicity include fluid loss like dehydration and diuretics, low sodium levels, decreased kidney function, or the specific use of NSAIDs or thiazide diuretics. Early signs of lithium toxicity include GI distress, which includes nausea, vomiting, and diarrhea.
Late signs of toxicity are neurological problems like loss of coordination, sedation, confusion, or seizures. Lithium is also teratogenic and should not be given during pregnancy. Lithium is a highly tested drug, but with this mnemonic, you'll be sure to nail all the lithium questions on the NCLEX.
Thanks for stopping by the Pixarized Comedy Club, and we'll see you in the next one. For more videos like this one, subscribe to our channel and check out our newest lessons. For more resources on this topic, including fact lists and interactive review images, click the image next to the More Here arrow. I'll see you next time.