lithium Nursing Considerations & Management

Drug Name

Generic Name :  lithium , lithium carbonate , lithium citrate

Brand Name: Carbolith (CAN), Duralith (CAN), Eskalith, Eskalith CR, Lithane (CAN), Lithobid, Lithonate, Lithotabs, PMS-Lithium Carbonate (CAN)

Classification: Antimanic drug

Pregnancy Category D

Dosage & Route
  • Acute mania: 600 mg PO tid or 900 mg slow-release form PO bid to produce effective serum levels between 1 and 1.5 mEq/L. Serum levels should be determined twice per wk in samples drawn immediately before a dose (at least 8–12 hr after previous dose).
  • Long-term use: 300 mg PO tid–qid to produce a serum level of 0.6–1.2 mEq/L. Serum levels should be determined at least every 2 mo in samples drawn immediately before a dose (at least 8–12 hr after previous dose).
  • Conversion from conventional to slow-release dosage forms: Give the same total daily dose divided into two or three doses.
  • Safety and efficacy for children < 12 yr not established.
  • Reduced dosage may be necessary. Elderly patients often respond to reduced dosage and may exhibit signs of toxicity at serum levels tolerated by other patients. Plasma half-life is prolonged in renal impairment.
Therapeutic actions
  • Lithium’s exact mechanism is unclear but it alters intraneuronal metabolism of catecholamines and sodium transport in neurons and muscle cells.
  • Treatment of manic episodes of manic-depressive illness; maintenance therapy to prevent or diminish frequency and intensity of subsequent manic episodes
  • Unlabeled use: Improvement of neutrophil counts in patients with cancer chemotherapy–induced neutropenia and in children with chronic neutropenia and HIV patients on zidovudine therapy (doses of 300–1,000 mg/day, serum levels of 0.5 and 1 mEq/L); prophylaxis of cluster headache and cyclic migraine headache, treatment of SIADH, hypothyroidism (doses of 600–900 mg/day)
Adverse effects
  • Exacerbation of psoriasis, acne, rash; nausea, diarrhoea, vertigo, muscle weakness, dazed feeling; loss of concentration; tremors; hypothyroidism; wt gain, oedema; cardiac arrhythmias; exophthalmos; restlessness; electrolyte disturbances.
  • Potentially Fatal: Severe neurotoxicity, leucopenia.
  • Severe renal and cardiac disease; severe dehydration, sodium depletion, debilitation.
Nursing considerations
  • History: Hypersensitivity to tartrazine; significant renal or CV disease; severe debilitation, dehydration; sodium depletion, patients on diuretics; protracted sweating, diarrhea; suicidal or impulsive patients; infection with fever; pregnancy; lactation
  • Physical: Weight and T; skin color, lesions; orientation, affect, reflexes; ophthalmic examination; P, BP, R, adventitious sounds; bowel sounds, normal output; normal fluid intake, normal output, voiding pattern; thyroid, renal glomerular and tubular function tests, urinalysis, CBC and differential, baseline ECG
  • Give with caution and daily monitoring of serum lithium levels to patients with renal or CV disease, debilitation, or dehydration or life-threatening psychiatric disorders.
  • Give drug with food or milk or after meals.
  •  BLACK BOX WARNING: Monitor clinical status closely, especially during initial stages of therapy; monitor for therapeutic serum levels of 0.6–1.2 mEq/L; toxicity is closely related to serum levels.
  • Individuals vary in their reponse to this drug; some patients may exhibit toxic signs at serum lithium levels considered within the therapeutic range.
  • Advise patient that this drug may cause serious fetal harm and cannot be used during pregnancy; urge use of barrier contraceptives.
  • Decrease dosage after the acute manic episode is controlled; lithium tolerance is greater during the acute manic phase and decreases when manic symptoms subside.
  • WARNING: Ensure that patient maintains adequate intake of salt and adequate intake of fluid (2,500–3,000 mL/day).
Teaching points
  • Take this drug exactly as prescribed, after meals or with food or milk. Swallow extended- or controlled-release tablets whole; do not chew or crush.
  • Eat a normal diet with normal salt intake; maintain adequate fluid intake (at least 2.5 quarts/day).
  • Arrange for frequent checkups, including blood tests. Keep all appointments for checkups to get the most benefits with the least toxicity.
  • Use contraception to avoid pregnancy. If you wish to become pregnant or believe that you have become pregnant, consult your health care provider.
  • Discontinue drug, and notify your health care provider if toxicity occurs—diarrhea, vomiting, ataxia, tremor, drowsiness, lack of coordination or muscular weakness.
  • You may experience these side effects: Drowsiness, dizziness (avoid driving or performing tasks that require alertness); GI upset (eat frequent small meals); mild thirst, greater than usual urine volume, fine hand tremor (may persist throughout therapy; notify your health care provider if severe).
  • Report diarrhea or fever.