QuestionSBA
QuestionChoice
As there are no signs of toxicity such as coarse tremor, dysarthria or ataxia, there is no need to stop his lithium immediately or carry out haemodialysis
34472
c
Carry out haemodialysis on the patient
QuestionChoice
It is also not advisable to ignore the raised serum level and maintain his current dose, appropriate investigation should be done to identify the cause of elevated lithium in order to guide management
34474
e
Maintain the dose of lithium carbonate
QuestionChoice
As there are no signs of toxicity such as coarse tremor, dysarthria or ataxia, there is no need to stop his lithium immediately or carry out haemodialysis
34471
b
Stop the lithium and restart at a 300mg OD
QuestionChoice
In this case, the patient had a serum lithium of 1.2mmol/L, which is higher than the target range, hence, further increasing the dose of lithium is inappropriate
34473
d
Increase the dose of lithium carbonate to 550mg OD
QuestionChoice
Lithium carbonate has a narrow therapeutic index and hence monitoring of serum lithium is often done to ensure it is within therapeutic range. Concentrations are often taken 12 hours after administration and target range of 0.8-1.0 mmol/L is required. The patient’s examination findings are mainly side effects of the medication and not signs of toxicity. Hence, it is necessary to repeat a serum lithium level and check if his renal function is affecting the clearance of lithium
34470
a
Recheck the level of lithium and his renal function
QuestionComment
fine tremor = early sign of lithium toxicity, BNF says to reduce dose
8561
QuestionComment
BNF: 'The early clinical features are non-specific and may include apathy and restlessness which could be confused with mental changes arising from the patient's depressive illness. Vomiting, diarrhoea, ataxia, weakness, dysarthria, muscle twitching, and tremor may follow. Severe poisoning is associated with convulsions, coma, renal failure, electrolyte imbalance, dehydration, and hypotension.'

This pt is only complaining of a fine tremor & metallic taste which are more consistent with side effects of lithium rather than toxicity. 
37180
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Abscess Jargon
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Gastro Haemophilus
QuestionComment
"... without features of ftoxicity, all that is usually necesary is to take measures to increase urine output (e.g. by increasing fluid intake but avoiding diuretics)"

So when it is out of the therapeutic window but there are no features of toxicity, you assess renal function and double check lithium levels (to ensure its not an anomaly). At the same time, you try to encourage more fluid intake and to pass more urine. 

If there are features of toxicity, you stop the dose. If conc is in excess of 2mmol/L, you consider haemodialysis (if neurological signs or renal failure present)
39689
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Biopsy Cystic
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2837
Lithium monitoring
Topic
89
Psychiatric Pharmacology
6905
Case Presentation:




A 45-year-old man was admitted to Psychiatry Ward following a failed suicidal attempt due to a depressive episode. PMH Bipolar disorder. DH Lithium carbonate 400mg PO OD.
Due to the acute relapse of her bipolar disorder, it has been decided that her lithium carbonate will be increased to 500mg OD and the first dose was given at 0800 today. Weight 75kg.


 **On Examination**
Patient had fine tremor on both hands and complained of a lingering metallic taste.
BP 118/75 mmHg, HR 75/min, RR 12, moist mucous membrane with CRT 2s.


 **Investigations**
Serum lithium at 2200 is 1.2 mmol/L (Therapeutic dose 0.6-1.0 mmol/L)


Question:
Select the most appropriate decision option based on these data.
a