Lithium -- Contraindications and Cautions
锂 -- 禁忌症与注意事项
Lithium is contraindicated in the presence of hypersensitivity to lithium. In addition, it is contraindicated in the following conditions: significant renal or cardiac disease that could be exacerbated by the toxic effects of the drug; a history of leukemia; metabolic disorders, including sodium depletion; dehydration; and diuretic use because lithium depletes sodium reabsorption, and severe hyponatremia may occur. (Hyponatremia leads to lithium retention and toxicity.) Pregnancy and lactation are also contraindications because of the potential for adverse effects on the fetus or neonate; breast-feeding should be discontinued while using lithium, and women of childbearing age should be advised to use birth control while taking this drug. Caution should be used in any condition that could alter sodium levels, such as protracted diarrhea or excessive sweating; with suicidal or impulsive patients; and in patients who have infection with fever, which could be exacerbated by the toxic effects of the drug.
The adverse effects associated with lithium are directly related to serum levels of the drug.
与锂相关的不良效应与药物的血清浓度直接相关。
• Serum levels of less than 1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, which relates to renal toxicity; and beginning of gastric toxicity, with nausea, vomiting, and diarrhea.
• Serum levels of 1.5 to 2 mEq/L: Intensification of all of the foregoing reactions, with ECG changes.
血清浓度1.5 – 2 mEq/L：前述反应增强，伴ECG变化。
• Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects to ataxia, clonic movements, hyperreflexia, and seizures; possible CV effects such as severe ECG changes and hypotension; large output of dilute urine secondary to renal toxicity; fatalities secondary to pulmonary toxicity.
• Serum levels greater than 2.5 mEq/L: Complex multiorgan toxicity, with a significant risk of death.
血清浓度大于2.5 mEq/L：复杂性多器官毒性，伴重大的死亡危险。
Drug–Drug Interactions
药药相互作用
Some drug–drug combinations should be avoided. A lithium–haloperidol combination may result in an encephalopathic syndrome, consisting of weakness, lethargy, confusion, tremors, extrapyramidal symptoms, leukocytosis, and irreversible brain damage .
sodium depletion – 低钠症、脱钠
polyuria – n. 多尿
foregoing – a. 上述的，前面的
ataxia – n.
clonic – a. 阵挛性的，间歇性抽搐的
fatality – n. 致命性，死亡（率）
secondary to – 继发于
multiorgan – a. n. 多器官
haloperidol – n. 氟哌啶醇
encephalopathic syndrome – 脑病综合征
1. A client prescribed lithium carbonate for the treatment of bipolar disorder has a medication blood level of 1.6 mEq/L (1.6 mmol/L). Which assessment question should the nurse ask to determine whether the client is experiencing signs of lithium toxicity associated with this level?
A. “Do you hear ringing in your ears?”
B. “Have you noted that your vision is blurred?”
C. “Have you fallen recently because you are dizzy?”
D. “Have you been experiencing any nausea, vomiting, or diarrhea?” 2. The nurse notes that a client’s lithium level is 3.9 mEq/L (3.9 mmol/L). Based on this data, which priority intervention should the nurse implement?
A. Determining visual acuity
B. Assisting with ambulation
C. Monitoring intake and output
D. Instituting seizure precautions
1. D. “Have you been experiencing any nausea, vomiting, or diarrhea?” Rationale: Normal lithium levels are between 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L). One of the most common early signs of lower level lithium toxicity is gastrointestinal (GI) disturbances such as nausea, vomiting, or diarrhea. The assessment questions in options A, B, and C are related to the findings in lithium toxicity at higher levels. 2. D. Instituting seizure precautions Rationale: The lithium level must be monitored closely in a client taking lithium. A therapeutic regimen is designed to attain a serum lithium level of 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L) for maintenance treatment. A level of 3.9 mEq/L (3.9 mmol/L) is in the toxic range, and seizures may occur at levels of 3.5 mEq/L (3.5 mmol/L) and higher. While the remaining options are appropriate interventions, they are not the priority because they are not related to the possibility of toxicity.
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