Major side effects include nausea, diarrhea, vomiting, fine hand tremor, sedation, muscular weakness, polydypsia, edema, weight gain and a dry mouth. Adverse effects from chronic use may include leukocytosis (reversible upon discontinuation of lithium), hypothyroidism and goiter, acne, psoriasis, terarogenesis (first trimester, although the risk is very low), nephrogenic diabetes insipidus (revesible), and kidney damage.
Signs of toxicity include lethargy, ataxia, slurred speech, tinnitis, severe nausea/vomiting, tremor, arrhythmias, hypotension, seizures, shock, delirium, coma and even death. Since the toxic range is near to the therapeutic range, blood levels and adverse effects must be monitored closely. In addition, a number of other clinical lab test should be conducted at the beginning of treatment and periodically thereafter.
Clinical Lad Test for Patients Taking Lithium:
-NA (Sodium)
-Ca (Calcium)
-P (Phosphorus)
-EKG
-Creatinine
-Urinalysis
-Complete CBC
-Thyroid battery with TSH
Common Treatment Errors to Avoid.
-Lithium very toxic thus warrants close monitoring (especially in suicidal patients. Note: Suicide occur frequently not only in depressed but also manic patients). Acute dehydration can also result in toxic lithium levels.
-Poor compliance
-Discontinuation: Note: Bipolar patients need life-long treatment to avoid relapse. Patient or physician/physician assistant/ARPN, initiated discontinuation can and does result in frequent relapse. And, subsequent episodes often are more severe and may become treatment-resistant. If discontinuation must occur, it is strongly recommended that it be done gradually or a period of 6 weeks.
Dulce M. Matamoros Columbie, PhD, CMHP, PA.
No comments:
Post a Comment