Lithium on the NCLEX
Lithium: therapeutic level, toxicity signs, hydration and sodium, pregnancy.
Lithium is a mood stabilizer with a narrow therapeutic window. The NCLEX tests level, toxicity, and the sodium/hydration interaction.
Therapeutic level
0.6-1.2 mEq/L maintenance. 0.8-1.2 in acute mania. >1.5 toxic. Levels drawn 12 hours after last dose.
Toxicity signs
Tremor (fine = therapeutic; coarse = toxic). N/V/D. Confusion, ataxia. Seizures, coma at severe toxicity.
Sodium and hydration
Lithium reabsorption follows sodium. Low sodium = lithium retention = toxicity. Dehydration = toxicity. Avoid low-salt diets. Maintain hydration.
Drug interactions
NSAIDs, ACE/ARB, thiazides decrease lithium clearance → toxicity. Caffeine increases clearance.
Pregnancy
First trimester: Ebstein's anomaly (cardiac defect) risk. Risk-benefit decision.
Frequently asked
Tremor on lithium, normal?
Fine hand tremor is common at therapeutic level. Coarse tremor = toxicity sign.
Patient skipping meals, risk?
Yes, dehydration and sodium variation cause level fluctuations.
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