Lithium is an alkali metal that has been used to treat bipolar disorder and other conditions. It has a narrow therapeutic window, and toxicity can occur with both acute and chronic overdoses. Symptoms of acute toxicity initially involve the GI system but then progress to the CNS, causing tremors, seizures, and potentially coma. Treatment involves fluid replacement and electrolyte monitoring, with dialysis for severe cases. Chronic toxicity poses the highest neurologic risk due to lithium accumulation in tissues over time.
Lithium is commonly used to treat mania associated with bipolar disorder. It works by regulating manic episodes. Common side effects include tremors, nausea, and thinning hair. Lithium toxicity can occur if lithium levels in the blood become too high and symptoms include diarrhea, vomiting, blurred vision, and irregular heartbeat. Nurses play an important role in monitoring lithium levels and educating patients to ensure proper dosing and prevent toxicity.
Lithium was first introduced as a treatment for mania in 1949 and approved by the FDA for this purpose in 1970. It is effective for treating manic episodes and preventing recurrent manic/depressive episodes in bipolar patients. Lithium is readily absorbed and distributed throughout extracellular fluid, reaching peak plasma levels within 2-4 hours. It is excreted primarily through the kidneys, with an elimination half-life of around 24 hours. Therapeutic lithium levels range from 0.6-1.2 mEq/L, depending on whether it is being used to treat an acute episode or for long-term maintenance. Adverse effects are generally dose-related and include nausea, tremors, and
The patient, a 53-year-old man with bipolar disorder treated with lithium carbonate, presented with loose stool, nausea, fatigue, and loss of energy over the past two days. His lithium level was found to be 3.17 mmol/L, above the therapeutic range of 0.50-1.20 mmol/L, indicating lithium toxicity. He was admitted and treated supportively with IV fluids and discontinuation of lithium. His lithium level decreased to 0.68 mmol/L after 4 days and he was discharged to psychiatric care after one week.
Lithium is approved for treating bipolar disorder and is dosed based on achieving a target serum level. Common side effects include thyroid dysfunction, diabetes insipidus, tremor, weight gain and cognitive impairment. Dosing must be adjusted for renal impairment and in elderly patients due to reduced clearance. Lithium has a half-life of 14-24 hours and is primarily excreted unchanged in the urine. Monitoring of serum levels and side effects is important during long-term lithium treatment.
This document discusses mood stabilizers, which are medications used to treat mood disorders like bipolar disorder. It describes bipolar disorder and its symptoms. The main types of mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and antipsychotics. Lithium was one of the first mood stabilizers and works by interfering with cell signaling pathways. Anticonvulsants also have mood stabilizing effects through mechanisms like enhancing GABA. Antipsychotics are used to treat mania and can have side effects like extrapyramidal symptoms. The goals of treatment are to reduce symptoms, prevent relapse, and improve functioning while reducing risks.
Mood stabilizers for (Bipolar disorder, Schizophrenia and Mania) Bhudev Global
This document provides information about mood stabilizers, their uses, mechanisms of action, and side effects. It discusses several individual drugs used as mood stabilizers including lithium, valproate, and carbamazepine. Lithium is described as the classic mood stabilizer that works by decreasing sodium content load and levels of neurotransmitters like norepinephrine and dopamine. Valproate and carbamazepine are also described as having GABAergic effects that contribute to their antimanic properties. Common and rare side effects are outlined for each drug along with details about drug interactions.
Lithium is the first identified treatment for bipolar disorder and is effective at preventing future episodes. It is thought to work by altering sodium transport across cell membranes and the metabolism of neurotransmitters like serotonin and catecholamines. Common side effects include diarrhea, nausea, weight gain, tremors and kidney problems. It can be augmented with other medications like antipsychotics or antidepressants but requires monitoring of kidney and thyroid function due to risks of toxicity.
Vascular dementia is caused by problems in the supply of blood to the brain, often due to conditions like strokes or mini-strokes. It is characterized by stepwise cognitive decline following vascular events and symptoms that overlap with Alzheimer's disease, though it often occurs at a younger age. Risk factors include age, history of strokes, high blood pressure, diabetes, smoking, and atrial fibrillation. Treatment focuses on controlling vascular risk factors and symptoms.
Lithium is commonly used to treat mania associated with bipolar disorder. It works by regulating manic episodes. Common side effects include tremors, nausea, and thinning hair. Lithium toxicity can occur if lithium levels in the blood become too high and symptoms include diarrhea, vomiting, blurred vision, and irregular heartbeat. Nurses play an important role in monitoring lithium levels and educating patients to ensure proper dosing and prevent toxicity.
Lithium was first introduced as a treatment for mania in 1949 and approved by the FDA for this purpose in 1970. It is effective for treating manic episodes and preventing recurrent manic/depressive episodes in bipolar patients. Lithium is readily absorbed and distributed throughout extracellular fluid, reaching peak plasma levels within 2-4 hours. It is excreted primarily through the kidneys, with an elimination half-life of around 24 hours. Therapeutic lithium levels range from 0.6-1.2 mEq/L, depending on whether it is being used to treat an acute episode or for long-term maintenance. Adverse effects are generally dose-related and include nausea, tremors, and
The patient, a 53-year-old man with bipolar disorder treated with lithium carbonate, presented with loose stool, nausea, fatigue, and loss of energy over the past two days. His lithium level was found to be 3.17 mmol/L, above the therapeutic range of 0.50-1.20 mmol/L, indicating lithium toxicity. He was admitted and treated supportively with IV fluids and discontinuation of lithium. His lithium level decreased to 0.68 mmol/L after 4 days and he was discharged to psychiatric care after one week.
Lithium is approved for treating bipolar disorder and is dosed based on achieving a target serum level. Common side effects include thyroid dysfunction, diabetes insipidus, tremor, weight gain and cognitive impairment. Dosing must be adjusted for renal impairment and in elderly patients due to reduced clearance. Lithium has a half-life of 14-24 hours and is primarily excreted unchanged in the urine. Monitoring of serum levels and side effects is important during long-term lithium treatment.
This document discusses mood stabilizers, which are medications used to treat mood disorders like bipolar disorder. It describes bipolar disorder and its symptoms. The main types of mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and antipsychotics. Lithium was one of the first mood stabilizers and works by interfering with cell signaling pathways. Anticonvulsants also have mood stabilizing effects through mechanisms like enhancing GABA. Antipsychotics are used to treat mania and can have side effects like extrapyramidal symptoms. The goals of treatment are to reduce symptoms, prevent relapse, and improve functioning while reducing risks.
Mood stabilizers for (Bipolar disorder, Schizophrenia and Mania) Bhudev Global
This document provides information about mood stabilizers, their uses, mechanisms of action, and side effects. It discusses several individual drugs used as mood stabilizers including lithium, valproate, and carbamazepine. Lithium is described as the classic mood stabilizer that works by decreasing sodium content load and levels of neurotransmitters like norepinephrine and dopamine. Valproate and carbamazepine are also described as having GABAergic effects that contribute to their antimanic properties. Common and rare side effects are outlined for each drug along with details about drug interactions.
Lithium is the first identified treatment for bipolar disorder and is effective at preventing future episodes. It is thought to work by altering sodium transport across cell membranes and the metabolism of neurotransmitters like serotonin and catecholamines. Common side effects include diarrhea, nausea, weight gain, tremors and kidney problems. It can be augmented with other medications like antipsychotics or antidepressants but requires monitoring of kidney and thyroid function due to risks of toxicity.
Vascular dementia is caused by problems in the supply of blood to the brain, often due to conditions like strokes or mini-strokes. It is characterized by stepwise cognitive decline following vascular events and symptoms that overlap with Alzheimer's disease, though it often occurs at a younger age. Risk factors include age, history of strokes, high blood pressure, diabetes, smoking, and atrial fibrillation. Treatment focuses on controlling vascular risk factors and symptoms.
This document discusses lithium, a mood stabilizing drug used to treat bipolar disorder. It describes lithium's indications, pharmacokinetics, mechanisms of action, dosage, therapeutic levels, side effects, toxicity, contraindications, and the nurse's role in monitoring patients taking lithium. Key responsibilities for nurses include assessing renal and thyroid function before starting lithium, ensuring regular dosing, monitoring for side effects, maintaining fluid balance, and obtaining frequent lithium level and lab tests.
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document discusses psychopharmacology and mood stabilizers, focusing on lithium. It describes how psychopharmacology studies drugs used to treat psychiatric disorders, which work by adjusting neurotransmitter levels in the brain. Mood stabilizers are medications that can decrease vulnerability to episodes of mania or depression without exacerbating current episodes. Commonly used mood stabilizers include lithium, carbamazepine, and sodium valproate. Lithium has been used since the late 1800s to treat bipolar disorder and works by decreasing abnormal brain activity, though its exact mechanism is unknown. Lithium requires monitoring due to its narrow therapeutic index and risk of toxicity.
Lithium is used to treat mania and gout. Its exact mechanism of action is unclear but it affects intracellular signaling pathways related to mood stabilization and energy metabolism. It is rapidly absorbed orally and excreted by the kidneys. Toxicity symptoms vary depending on lithium levels and can include nausea, arrhythmias, neurological effects, and renal issues. Diagnosis is based on history, exam, and serum lithium concentration. Treatment involves hydration, gastrointestinal decontamination, and hemodialysis in severe cases.
This document discusses mood disorders like mania, depression and bipolar disorder. It provides details about lithium carbonate, which is a primary drug used to treat mania and bipolar disorder but has a low therapeutic index. The document summarizes lithium's mechanism of action, efficacy, adverse effects, drug interactions and monitoring considerations. It also mentions alternatives to lithium like various anti-convulsants and atypical antipsychotics that are now commonly used to control mania.
This slide contains information regarding Lithium Toxicity. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
This document provides an overview of delirium, including its introduction, history, epidemiology, etiology, neuropathology, diagnosis, differential diagnosis, course, prevention and management. Delirium is characterized by an acute change in mental status and cognition that fluctuates over the course of a day. It has a prevalence of 5-55% among elderly hospitalized patients and is associated with increased mortality, longer hospital stays and higher healthcare costs. The pathophysiology involves multiple neurotransmitter systems and risk factors include predisposing patient factors and precipitating insults like infection, medication side effects or metabolic disturbances. Prevention focuses on reducing risk factors and early diagnosis and treatment can improve outcomes.
This document provides an overview of delirium, including its definition, history, characteristics, epidemiology, risk factors, causes, pathophysiology, clinical features, diagnosis, differential diagnosis, course and prognosis, and treatment. Some key points covered include:
- Delirium is defined as an acute impairment of attention, consciousness, and cognition that fluctuates in severity.
- Risk factors include older age, medical illnesses, cognitive impairment, and polypharmacy.
- Causes include infections, withdrawal, toxins/drugs, hypoxia, and metabolic disturbances.
- The pathophysiology is not fully understood but may involve neurotransmitter imbalances and blood-brain barrier disruption.
- Diagnosis involves
Lithium intoxication can cause mild symptoms like weakness and nausea or more severe symptoms like delirium, coma, and organ damage. Long term effects are also possible and include neurological issues like cerebellar dysfunction. Diagnosis involves checking the history, lithium serum level, ECG, and other tests. Treatment focuses on hydration, blocking lithium reabsorption, gastric lavage if recent ingestion, and hemodialysis for moderate to severe cases to reduce the lithium level quickly. Special care is needed to avoid hypernatremia in patients with kidney issues.
Delusion is a strong fixed unshakable belief irrespective of sociocultural background. The document defines delusion and lists 10 common types, including delusions of persecution, grandeur, and reference. It discusses managing delusions through psychological therapies, pharmacological treatments, strategies for working with delusional patients, and barriers to intervention. Nursing management focuses on addressing disturbed thought processes, impaired self-care and communication, ineffective health maintenance, and ineffective family coping.
This document discusses extrapyramidal symptoms, which are movement disorders that result from disruption of the basal ganglia network in the brain. It provides an overview of the anatomy of the basal ganglia and their role in motor control. It then presents a case scenario of a 16-year-old boy who developed acute dystonia after taking an unspecified nausea medication, likely causing the extrapyramidal symptom. The document outlines different extrapyramidal symptoms like parkinsonism, acute dystonia, neuroleptic malignant syndrome, and tardive dyskinesia. It provides recommendations for treating each condition, such as using procyclidine or benztropine for acute dystonia.
The document provides an overview of sleep and sleep disorders presented by Dr. Kaushik Nandi. It discusses the neurobiology of sleep and wakefulness including the arousal spectrum and sleep/wake switch regulated by neurotransmitters and brain regions like the hypothalamus. The stages of sleep are described based on EEG patterns and physiological characteristics. Assessment methods and classifications of sleep disorders by the DSM-5 and ICSD-3 are outlined. Insomnia disorder and Narcolepsy are explained in more detail regarding their diagnostic criteria, epidemiology, etiology, pathophysiology and treatment approaches.
Mania is an abnormally elevated mood state characterized by inappropriate elation, irritability, insomnia, grandiose notions, increased speech and thoughts, and poor judgment. It is caused by biological and psychosocial factors and can be treated with mood stabilizers, antipsychotics, ECT, and psychotherapy. Nurses assess severity, monitor for injury/violence risks, address nutrition issues, and support social interaction for patients experiencing mania.
The document discusses mood stabilizers, including their history, mechanisms of action, indications, monitoring, and side effects. It notes that lithium was the first mood stabilizer approved by the FDA for mania in 1970. Other common mood stabilizers mentioned are anticonvulsants such as valproate, lamotrigine, carbamazepine, and atypical antipsychotics. The effectiveness and safety of combination treatments is also summarized.
Everyone occasionally feels blue or sad. But
these feelings are usually short-lived and pass within a couple of days. When
you have depression, it interferes with daily life and causes pain for both you
and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never
seek treatment. But the majority, even those with the most severe depression,
can get better with treatment. Medications, psychotherapies, and other methods
can effectively treat people with depression.
NIMH
Substance abuse refers to disorders arising from the abuse of alcohol, drugs, and other chemicals. It is classified as F1 in ICD-10. Addiction involves physiological and psychological dependence on a substance, while abuse refers to impaired health. Dependence involves tolerance and withdrawal symptoms. Alcohol dependence is a chronic condition characterized by excessive and compulsive drinking that impairs functioning. It commonly leads to physical and psychological dependence as well as health, social, and legal problems. Relapse is the return to substance abuse after a period of abstinence.
This document provides an overview of the treatment of dementia. It discusses the definition and classification of dementia, as well as the staging and types of dementia. It then describes the pathophysiology and management of dementia, including both pharmacologic and non-pharmacologic approaches. Regarding pharmacologic management, it outlines three broad categories of treatment: symptomatic treatment of memory disturbance, disease-modifying treatments, and symptomatic treatment of behavioral disturbances. Specific drugs discussed in detail include cholinesterase inhibitors such as donepezil, rivastigmine, and tacrine.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
Lithium toxicity occurs when lithium levels in the blood become too high, usually due to factors like dehydration or medication interactions. Symptoms range from hand tremors and nausea to seizures and coma. Treatment involves rehydration, activated charcoal, hemodialysis for severe cases, and managing symptoms like seizures. The main goals are supporting life functions, enhancing lithium elimination from the body, and treating any complications until lithium levels decrease to a safe range. Lithium toxicity can be acute from overdose or chronic from a build up over time while taking lithium medications.
What a nephrologist needs to know about lithium intoxicationAris Tsalouchos
Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is often recommended to treat lithium poisoning. This presentation describes what nephrologist needs to know about lithium intoxication treatment.
This document discusses lithium, a mood stabilizing drug used to treat bipolar disorder. It describes lithium's indications, pharmacokinetics, mechanisms of action, dosage, therapeutic levels, side effects, toxicity, contraindications, and the nurse's role in monitoring patients taking lithium. Key responsibilities for nurses include assessing renal and thyroid function before starting lithium, ensuring regular dosing, monitoring for side effects, maintaining fluid balance, and obtaining frequent lithium level and lab tests.
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document discusses psychopharmacology and mood stabilizers, focusing on lithium. It describes how psychopharmacology studies drugs used to treat psychiatric disorders, which work by adjusting neurotransmitter levels in the brain. Mood stabilizers are medications that can decrease vulnerability to episodes of mania or depression without exacerbating current episodes. Commonly used mood stabilizers include lithium, carbamazepine, and sodium valproate. Lithium has been used since the late 1800s to treat bipolar disorder and works by decreasing abnormal brain activity, though its exact mechanism is unknown. Lithium requires monitoring due to its narrow therapeutic index and risk of toxicity.
Lithium is used to treat mania and gout. Its exact mechanism of action is unclear but it affects intracellular signaling pathways related to mood stabilization and energy metabolism. It is rapidly absorbed orally and excreted by the kidneys. Toxicity symptoms vary depending on lithium levels and can include nausea, arrhythmias, neurological effects, and renal issues. Diagnosis is based on history, exam, and serum lithium concentration. Treatment involves hydration, gastrointestinal decontamination, and hemodialysis in severe cases.
This document discusses mood disorders like mania, depression and bipolar disorder. It provides details about lithium carbonate, which is a primary drug used to treat mania and bipolar disorder but has a low therapeutic index. The document summarizes lithium's mechanism of action, efficacy, adverse effects, drug interactions and monitoring considerations. It also mentions alternatives to lithium like various anti-convulsants and atypical antipsychotics that are now commonly used to control mania.
This slide contains information regarding Lithium Toxicity. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
This document provides an overview of delirium, including its introduction, history, epidemiology, etiology, neuropathology, diagnosis, differential diagnosis, course, prevention and management. Delirium is characterized by an acute change in mental status and cognition that fluctuates over the course of a day. It has a prevalence of 5-55% among elderly hospitalized patients and is associated with increased mortality, longer hospital stays and higher healthcare costs. The pathophysiology involves multiple neurotransmitter systems and risk factors include predisposing patient factors and precipitating insults like infection, medication side effects or metabolic disturbances. Prevention focuses on reducing risk factors and early diagnosis and treatment can improve outcomes.
This document provides an overview of delirium, including its definition, history, characteristics, epidemiology, risk factors, causes, pathophysiology, clinical features, diagnosis, differential diagnosis, course and prognosis, and treatment. Some key points covered include:
- Delirium is defined as an acute impairment of attention, consciousness, and cognition that fluctuates in severity.
- Risk factors include older age, medical illnesses, cognitive impairment, and polypharmacy.
- Causes include infections, withdrawal, toxins/drugs, hypoxia, and metabolic disturbances.
- The pathophysiology is not fully understood but may involve neurotransmitter imbalances and blood-brain barrier disruption.
- Diagnosis involves
Lithium intoxication can cause mild symptoms like weakness and nausea or more severe symptoms like delirium, coma, and organ damage. Long term effects are also possible and include neurological issues like cerebellar dysfunction. Diagnosis involves checking the history, lithium serum level, ECG, and other tests. Treatment focuses on hydration, blocking lithium reabsorption, gastric lavage if recent ingestion, and hemodialysis for moderate to severe cases to reduce the lithium level quickly. Special care is needed to avoid hypernatremia in patients with kidney issues.
Delusion is a strong fixed unshakable belief irrespective of sociocultural background. The document defines delusion and lists 10 common types, including delusions of persecution, grandeur, and reference. It discusses managing delusions through psychological therapies, pharmacological treatments, strategies for working with delusional patients, and barriers to intervention. Nursing management focuses on addressing disturbed thought processes, impaired self-care and communication, ineffective health maintenance, and ineffective family coping.
This document discusses extrapyramidal symptoms, which are movement disorders that result from disruption of the basal ganglia network in the brain. It provides an overview of the anatomy of the basal ganglia and their role in motor control. It then presents a case scenario of a 16-year-old boy who developed acute dystonia after taking an unspecified nausea medication, likely causing the extrapyramidal symptom. The document outlines different extrapyramidal symptoms like parkinsonism, acute dystonia, neuroleptic malignant syndrome, and tardive dyskinesia. It provides recommendations for treating each condition, such as using procyclidine or benztropine for acute dystonia.
The document provides an overview of sleep and sleep disorders presented by Dr. Kaushik Nandi. It discusses the neurobiology of sleep and wakefulness including the arousal spectrum and sleep/wake switch regulated by neurotransmitters and brain regions like the hypothalamus. The stages of sleep are described based on EEG patterns and physiological characteristics. Assessment methods and classifications of sleep disorders by the DSM-5 and ICSD-3 are outlined. Insomnia disorder and Narcolepsy are explained in more detail regarding their diagnostic criteria, epidemiology, etiology, pathophysiology and treatment approaches.
Mania is an abnormally elevated mood state characterized by inappropriate elation, irritability, insomnia, grandiose notions, increased speech and thoughts, and poor judgment. It is caused by biological and psychosocial factors and can be treated with mood stabilizers, antipsychotics, ECT, and psychotherapy. Nurses assess severity, monitor for injury/violence risks, address nutrition issues, and support social interaction for patients experiencing mania.
The document discusses mood stabilizers, including their history, mechanisms of action, indications, monitoring, and side effects. It notes that lithium was the first mood stabilizer approved by the FDA for mania in 1970. Other common mood stabilizers mentioned are anticonvulsants such as valproate, lamotrigine, carbamazepine, and atypical antipsychotics. The effectiveness and safety of combination treatments is also summarized.
Everyone occasionally feels blue or sad. But
these feelings are usually short-lived and pass within a couple of days. When
you have depression, it interferes with daily life and causes pain for both you
and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never
seek treatment. But the majority, even those with the most severe depression,
can get better with treatment. Medications, psychotherapies, and other methods
can effectively treat people with depression.
NIMH
Substance abuse refers to disorders arising from the abuse of alcohol, drugs, and other chemicals. It is classified as F1 in ICD-10. Addiction involves physiological and psychological dependence on a substance, while abuse refers to impaired health. Dependence involves tolerance and withdrawal symptoms. Alcohol dependence is a chronic condition characterized by excessive and compulsive drinking that impairs functioning. It commonly leads to physical and psychological dependence as well as health, social, and legal problems. Relapse is the return to substance abuse after a period of abstinence.
This document provides an overview of the treatment of dementia. It discusses the definition and classification of dementia, as well as the staging and types of dementia. It then describes the pathophysiology and management of dementia, including both pharmacologic and non-pharmacologic approaches. Regarding pharmacologic management, it outlines three broad categories of treatment: symptomatic treatment of memory disturbance, disease-modifying treatments, and symptomatic treatment of behavioral disturbances. Specific drugs discussed in detail include cholinesterase inhibitors such as donepezil, rivastigmine, and tacrine.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
Lithium toxicity occurs when lithium levels in the blood become too high, usually due to factors like dehydration or medication interactions. Symptoms range from hand tremors and nausea to seizures and coma. Treatment involves rehydration, activated charcoal, hemodialysis for severe cases, and managing symptoms like seizures. The main goals are supporting life functions, enhancing lithium elimination from the body, and treating any complications until lithium levels decrease to a safe range. Lithium toxicity can be acute from overdose or chronic from a build up over time while taking lithium medications.
What a nephrologist needs to know about lithium intoxicationAris Tsalouchos
Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is often recommended to treat lithium poisoning. This presentation describes what nephrologist needs to know about lithium intoxication treatment.
Pharmacology of Drugs used in bipolar disorder & maniashikha dwivedi
Bipolar disorder involves mood swings between mania and depression. Drugs used to treat it include lithium, antiepileptics like valproate and carbamazepine, and atypical antipsychotics. Lithium is well-established as an antimanic and mood stabilizing drug. It works by altering signal transduction pathways and inhibiting enzymes like inositol monophosphatase. Lithium, valproate, and atypical antipsychotics are effective for acute mania, while lithium, lamotrigine, and some antipsychotics can help prevent future mood episodes as maintenance therapy. Careful monitoring of lithium levels is needed due to its narrow therapeutic window.
This document discusses mood stabilizers including lithium, various anticonvulsants, and atypical antipsychotics. It provides in-depth information on the mechanisms of action, clinical indications, dosing, monitoring, side effects, and toxicity of lithium and sodium valproate. Lithium is effective for manic episodes, suicide prevention, and maintenance treatment in bipolar disorder. Valproate is proven effective for acute mania and commonly used long-term to prevent manic recurrence. Both require monitoring of plasma levels and side effects like gastrointestinal issues, tremors, and potential renal and thyroid impacts.
Keshav kumar panwar group no. 9 1st year 2 sem lithium (2)TigerJi1
Lithium is a naturally occurring alkali metal present in trace amounts in the human body. It is used as a mood stabilizer to treat bipolar disorder and prevent manic-depressive episodes. While lithium has antidepressant effects, high concentrations can damage the nervous system, kidneys, and endocrine system by causing issues like hypothyroidism. Research on lithium's mechanism of action has yielded inconsistent results, but it may work by influencing neurotransmitter levels and second messenger systems in the brain.
Lithium is a monovalent cation that is absorbed within 6-8 hours of ingestion and reaches peak plasma levels within 2 hours. It has a plasma half-life of about 20 hours. Therapeutic plasma concentrations are between 0.6-1.4 mEq/L, achieved through a daily dosage of 0.5 mEq/kg divided into doses. Lithium is not metabolized and is excreted by the kidneys. Its pharmacological effects are through inhibition of inositol signaling and glycogen synthase kinase-3. This modulates intracellular signaling pathways involved in mood, neuroprotection, and neuroplasticity.
Antimanic drugs like lithium are used to treat bipolar disorder by stabilizing moods and controlling symptoms of mania. Lithium was the first drug approved for this use and remains a standard treatment. It likely works by influencing neurotransmitter levels in the brain or reducing nerve impulse excitability. Other antimanic drugs include anticonvulsants and atypical antipsychotics. While effective, lithium requires monitoring due to potential side effects like nausea, thirst, and toxicity at high levels impacting the kidneys, heart, and brain.
Lithium intoxication can cause mild symptoms like weakness and nausea or more severe symptoms like delirium, coma, and organ damage. Long term effects are also possible and include neurological issues like cerebellar dysfunction. Diagnosis involves checking the patient's history, measuring lithium levels in their blood, and conducting tests like ECG and bloodwork. Treatment focuses on hydration, electrolyte balance, gastric lavage, diuretics, and hemodialysis for moderate to severe cases to reduce lithium levels in the blood. Special care must be taken with fluid management in patients at risk for lithium-induced diabetes insipidus. Hemodialysis is the primary treatment for severe lithium toxicity due to lith
Lithium orotate experience: What can you get from taking lithium orotate?phcoker.com
One of the most important lithium orotate benefits is that it protects the brain through the production of new brain cells and protection against the loss of brain cells. It has also shown to reverse dementia, Parkinson’s, and Alzheimer’s disease.
Animal studies on lithium orotate brain effects showed improvement in strokes and traumatic brain injuries. It can also provide benefits as a protectant against damage of the central nervous system due to Lyme disease
https://www.phcoker.com/lithium-orotate/
info@phcoker.com
This document discusses drugs used to treat mania. It begins by defining mania as a state of abnormally elevated mood and energy. Lithium carbonate is described as the first drug found to effectively treat mania through suppressing manic episodes and preventing mood cycling. The mechanisms of lithium's action and its use, efficacy, adverse effects, and interactions are explained in detail. Alternatives to lithium that are commonly used include sodium valproate, carbamazepine, lamotrigine, and atypical antipsychotics either alone or in combination with other drugs. These alternatives are described as having comparable efficacy to lithium in treating acute mania and maintaining remission of bipolar disorder.
Antimanic drugs are used to treat episodes of mania in bipolar disorder. Mania involves exaggerated feelings of well-being and hyperactivity that can include delusions and psychosis. Three commonly used antimanic drugs are lithium, anticonvulsants like carbamazepine and valproic acid, and atypical antipsychotics. These drugs are believed to work by influencing neurotransmitters like dopamine and serotonin or reducing brain cell excitability. Lithium is the standard treatment and works long-term to reduce manic episodes, though it requires monitoring due to potential side effects like lithium toxicity, hypothyroidism, weight gain and renal problems. Antimanic drugs aim to safely manage manic
This document provides an overview of lithium, including its chemistry, pharmacokinetics, mechanisms of action, therapeutic indications, and guidelines for use. It discusses how lithium is approved for treating manic episodes and maintenance therapy in bipolar disorder. Specifically, lithium is effective for reducing the frequency, severity and duration of manic and depressive episodes when used long-term for maintenance. It also significantly reduces suicide risk. Guidelines recommend initiating lithium maintenance therapy after one or two episodes to prevent future episodes from occurring.
Lithium is effective in treating acute mania and preventing manic episodes in bipolar disorder. It works by altering sodium transport across cell membranes and the metabolism of neurotransmitters like serotonin and dopamine. Lithium has a narrow therapeutic window, so monitoring plasma levels is essential. Common side effects include gastrointestinal issues and neurological effects like tremors or disorientation, while serious toxicity over 2mmol/L can cause seizures or even death.
overview of calcium physiology
vitamin d deficiency, hypoparathyroidism, pseudohypoparathyroidism, secondary hyperparathyroidism, hypoalbuminemia and calcium
Lithium toxicity occurs when there are excessive levels of lithium in the blood. Symptoms range from mild like nausea and weakness to severe including seizures, coma and even death. Management involves stopping lithium intake, intravenous fluids to hydrate the patient, monitoring vital signs and blood lithium levels, and potentially interventions like dialysis. Nurses play an important role in monitoring patients on lithium therapy, educating them on signs of toxicity, and ensuring safe lithium levels through regular blood tests.
This document discusses mood stabilizing agents used to treat bipolar disorder. It begins with a brief history of lithium, discovered in 1817 and first used to treat mania in 1871. By the 20th century its use declined due to toxicity but was rediscovered in 1949. The document outlines various drugs used as mood stabilizers including lithium, anticonvulsants, and atypical antipsychotics. It discusses the pharmacokinetics, mechanisms of action, indications, side effects, and nurses' responsibilities regarding these important medications.
Therapeutic drug monitoring of lithium involves monitoring lithium levels in patients taking lithium carbonate to treat conditions like bipolar disorder. Key points:
- Lithium is most commonly used as a mood stabilizer to treat manic episodes of bipolar disorder.
- Therapeutic lithium levels range from 0.6 to 1.25 mEq/L, with levels of 0.9 to 1.1 mEq/L favored for treating acute mania.
- Factors like diuretics, dehydration, and medications can impact lithium levels, so monitoring is important to avoid toxicity from levels above 1.5 mEq/L or below therapeutic ranges.
- Blood
1. Lithium is used to treat and prevent mania and bipolar disorder. It works by inhibiting neurotransmitter release in the brain.
2. It is excreted unchanged in the urine, so renal impairment increases the risk of toxicity. The dose must be carefully monitored and reduced in renal impairment.
3. Toxicity can occur even at therapeutic levels and includes tremors, ataxia, confusion, seizures, and cardiac issues. Hemodialysis is required to treat severe toxicity.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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1. Nisreen Sami Hassab
Higher Diploma in
Toxicology & Pharmacology
Supervised by:-
Dr. Ammar Ali Hussein
2019
LITHIUM TOXOICITY
2. Lithium (Li), chemical element of Group 1 (Ia) in the periodic table,
the alkali metal group, lightest of the solid elements. The metal itself—which
is soft, white, and lustrous—and several of its alloys and compounds are
produced on an industrial scale.
It has a single valence electron, which it readily loses to become the
positively charged cation.
"Lithia" water was first used in the late 1800s to treat mania and gout. Over
time, and likely due to low lithium content, "Lithia" water was ultimately
replaced by lithium tablets. With the higher concentrations in the tablets,
lithium's association with tremors and weakness became apparent and in
1898the first descriptions of lithium toxicity appeared.
3. About a half century later, the calming effects of lithium in 10 patients
with mania were described ; the drug's more toxic effects were
recognized when lithium chloride was used as a salt substitute in
patients with heart failure in 1949 .
Lithium's toxic effects limited its clinical use until appropriate serum
monitoring became more readily available. In the 1970s, Lithium
carbonate was approved in the United States for the treatment of acute
mania and bipolar disorder and it has been in use ever since( FDA)
banned the use it in 1940s because the fatalities but lifted the ban in
1970s.
In 2016, there were 6901 cases of lithium intoxication reported to the
American Association of Poison Control Centers .
4.
5. What important elements share a similar valence with lithium?
Sodium and potassium.
Lithium is usually administered orally as a salt in combination with what anion?
Lithium carbonate (Li2CO3). Lithium citrate and lithium orotate are also used.
6. What is the mechanism of action of lithium?
While exact mechanisms are unknown, lithium appears to modulate the
release of serotonin and norepinephrine. lithium has been used as a mood
stabilizing agent, its mechanism of action remains elusive but may reflect
alterations in transduction pathways related to glutamate, inositol
monophosphate, and glycogen synthase kinase 3 in the central nervous
system (CNS). Lithium has been shown to decrease the release of
noradrenaline and dopamine from nerve terminals and may also transiently
increase the release of serotonin, which may account for its mood stabilizing
properties.
Lithium has a very narrow therapeutic index, and clinical features of toxicity
can be noted at plasma lithium concentrations .Patients with bipolar affective
disorder have diminished GABA neurotransmission. Thus, low GABA levels
can result in excitatory toxicity. Lithium increases the levels of GABA which in
turn reduces glutamate and down regulates the NMDA receptor. Lithium also
directly activates the GABA receptor .
.
7. Clinical Features of Lithium Toxicity:-
Influence of the Pattern of Exposure on Lithium Pharmacokinetics, and the Onset
and Offset of Toxicity Although lithium can eventually lead to multisystem toxicity,
lithium’s most important site of toxicity is the CNS.
The risk of development of neurotoxicity is directly related to the pattern of
exposure that led to the poisoning, which in turn reflects the pharmacokinetic
properties of lithium. There are 3 patterns of lithium poisoning: acute, acute-on-
chronic, and chronic .
The risk of neurotoxicity is lowest with acute poisoning and highest with chronic
poisoning, owing to the differences in the opportunity for lithium to distribute to the
intracellular space in the CNS, relative to the plasma concentration–time profile.
Over a number of hours post ingestion, lithium distributes into the whole body
water. The rate at which it distributes in, and then out of, intracellular spaces is
slow relative to the rate at which lithium is eliminated from the body.
8. The blood–brain barrier may additionally slow distribution into the
brain. Because the intracellular concentration in the brain is
considered the main site of toxicity of lithium, Chronic poisoning
occurs when lithium intake exceeds elimination on a chronic basis,
usually weeks, Finally, acute-on-chronic poisoning occurs when an
individual who is already taking lithium chronically takes an acute
overdose. Here, the risk of neurotoxicity depends on the steady-state
concentration prior to the overdose.
9.
10. What are four medical indications for lithium use?
1. Bipolar disorder
2. Depression (often in combination with antidepressants)
3. Prevention of migraine and cluster headaches
4. Treatment of thyroid storm in patients with iodine allergy.
What are four nonmedical uses of lithium?
1. Batteries
2. Mixed with alloys of aluminum, cadmium, and copper to make aircraft parts
3. Lithium chloride (LiCl) is a dessicant.
4. Lithium hydroxide (LiOH) is used to scavenge carbon dioxide in submarines
and spacecraft, forming lithium carbonate.
What are the clinical findings of acute lithium toxicity?
Initial findings manifest as GI symptoms, including nausea, vomiting, and
diarrhea. This is followed by CNS symptoms, including tremor, nystagmus,
fasciculations, ataxia, hyperreflexia, lethargy, seizures, and coma.
What ECG findings occur with lithium toxicity?
1. Flattened or inverted T-waves
2. ST depression
11.
12. •Box 1. Drug Interactions That Can Increase Plasma Lithium
Concentrations:-
Nonsteroidal anti-inflammatory
drugs (NSAIDS), Renin-
angiotensin system inhibitors
Reduce glomerular filtration rate
(GFR)
Thiazide diuretics,
Spironolactone
5 Promote renal tubular
reabsorption
Calcium channel blockers
(diltiazem, verapamil).
Nifedipine has been shown to
reduce lithium clearance when
administered chronically
Uncertain mechanism
13. •Box 2. Clinical Manifestations of Lithium
Poisoning.
Manifestation:Organ system:
Wandering atrial pacemaker , sinus bradycardia, ST-
segment elevation, unmasking Brugada syndrome,
prolonged QT interval Uncommonly, life-threatening
arrhythmias
Cardiovascular
Lethargy, ataxia, confusion, agitation, neuromuscular
excitability (irregular coarse tremors, fasciculations,
myoclonic jerks, hyperreflexia) Severe lithium
toxicity can manifests as seizures, including
nonconvulsive status epilepticus
Neurological
Nausea, vomiting, diarrhoea, ileusGastrointestinal
16. •Acute poisoning:
• It is generally stated that ingestion of >7.5 mg/kg of elemental lithium
(approximately 40 mg/kg of lithium carbonate) is associated with an increased
risk of toxicity. This dose corresponds to a concentration of 1.4 mmol/L elemental
lithium in the body water phase. However, acute overdoses generally confer a
better prognosis due to the lower risk of neurotoxicity because lithium will not
have had sufficient time to accumulate in the brain or other tissues, relative to
the shorter time required for distribution to less toxic sites (eg, erythrocytes,
muscle) and excretion.
•Acute-on-chronic poisoning:
• Here, the risk of neurotoxicity is higher than in acute poisoning because
some lithium has already distributed to the intracellular space in the CNS prior to
poisoning , patient who did not receive dialysis despite very high plasma lithium
concentrations (10.6 mmol/L at 13 hours after ingestion)
• with acute-on-chronic poisoning .
17. •Chronic poisoning:
•This mode of poisoning confers the highest risk of
neurotoxicity for 2 reasons,first, the time course (usually
weeks) maximizes the opportunity for lithium to distribute
to the CNS compartment and to accumulate in neural tissue
and induce toxicity , Second, the half-life of lithium is
prolonged in chronic poisoning compared to acute29 which
reflects both the redistribution of lithium from the
intracellular compartment to the vascular compartment and
possibly changes in renal handling of lithium such as seen
in nephrogenic diabetes insipidus.
18. Pregnancy and breast feeding:-
• Lithium is a teratogen, causing birth defects in a small number of newborn
babies. and several retrospective studies have demonstrated possible increases in
the rate of a congenital heart defect known as , if taken during a woman's
pregnancy. As a consequence, fetal echocardiography is routinely performed in
pregnant women taking lithium to exclude the possibility of cardiac
anomalies. Lamotrigine seems to be a possible alternative to lithium in pregnant
women for the treatment of acute bipolar depression or for the management of
bipolar patients with normal mood. Gabapentin and clonazepam are also
indicated as antipanic medications during the childbearing years and
during pregnancy. Valproic acid and carbamazepine also tend to be associated
with teratogenicity.
• While it appears to be safe to use while breastfeeding a number of guidelines
list it as a contraindication .
19. • Patient factor:-
• Nephrogenic diabetes insipidus:
the most common renal side effect of lithium, which predisposes the individual
to volume depletion, in particular free water, with consequent activation of the
renin–angiotensin aldosterone system which promotes lithium reabsorption.
Age older than 50 years: It may reflect age-related reduction in physical
reserve and/or increased prevalence of polypharmacy associated with this age-
group that predisposes to lithium poisoning.
• Renal impairment:
Lithium excretion is almost exclusively dependent on glomerular filtration rate
(GFR), Estimated GFR < 45 mL/min/1.73 m2,
Kidney Disease, In adults without a baseline serum creatinine, serum
creatinine > 176 mmol/L in adults, or > 132 mmol/L in the elderly patients or those
with low muscle mass Serum creatinine greater than 2 times the upper limit of
normal for age and weight in children without a baseline serum creatinine
concentration The presence of oligo/anuria .
20. •Thyroid dysfunction:
The prevalence of clinical hypothyroidism is increased in patients
taking lithium therapy, hyperthyroidism can increase lithium
reabsorption thereby reducing lithium excretionm therapy and may
lead to volume depletion secondary to the osmotic effects of
hypercalcemia.
The role of activated charcoal in the treatment of lithium toxicity?
It is a poor binder of lithium and is not useful in isolated lithium
ingestion; it should be given if there is a possibility of a recent co-
ingestion.
21. Describe the treatment for acute lithium toxicity:-
1. Optimize fluid and electrolyte (especially sodium) status to
increase renal excretion of lithium.
2. Whole bowel irrigation may be used to limit absorption.
3. Dialysis may be considered for severe neurotoxicity, but
forced diuresis plays no role in treatment.
The treatment for chronic lithium toxicity:-
Similar to that of acute toxicity; however, since CNS tissue
concentrations arelikely to be higher and neurologic symptoms
are likely to be more prominent, hemodialysis should play a
greater role in treatment.
22. Treatment:-
Stomach pumping. This procedure may be an option if you’ve taken lithium
within the last hour.
Whole bowel irrigation. You’ll swallow a solution or be given one through a tube
to help flush the extra lithium out of your intestines.
IV fluids. You may need these to restore your electrolyte balance.
Hemodialysis. This procedure uses an artificial kidney, called a hemodialyzer, to
remove waste from your blood.
Medication. If you start to have seizures, your doctor might prescribe an
anticonvulsant medication.
Vital sign monitoring. Your doctor may choose to keep you under supervision
while they monitor your vital signs, including your blood pressure and heart rate,
for any unusual signs.
Lithium toxicity can have lasting effects, so it’s important to seek medical
attention immediately if you think you may have it. Avoid home remedies, such
as activated charcoal, which doesn’t bind to lithium.
Sodium Polystyrene Sulfonate. Sodium polystyrene sulfonate is an ion exchange
resin that can be used as an adjunctive treatment for the management of
hyperkalemia.
23. Diuretics:-
The addition of amiloride and/or furosemide may
theoretically enhance lithium elimination by blocking
reabsorption in the renal tubules. Also, amiloride is a
proposed treatment for lithium-induced nephrogenic
diabetes insipidus. Amiloride blocks the epithelial sodium
channel located at the apical membrane of the principal
cells in the distal convoluted tubules and collection
system, which may reduce reabsorption.
24. Conclusion :-
Despite the diverse presentation of lithium toxicity, it remains a
common drug to treat a multitude of psychiatric disorders. Given its
prevalence in the community, it is important to recognize the initial
presentation of lithium toxicity as further progression can cause
development of permanent neurologic disorders and severe renal
dysfunction. Finally, always consider drug interactions, especially
with other antipsychotic medications as well as nephrotoxic agents,
particularly since the combination of these drugs with lithium
increases the risk of toxicity.
25.
26. References:-
1_Toxicology recall / editors, Christopher P. Holstege, Matthew P.
Borloz, John P. Benner ; associate
editors, David T. Lawrence, Nathan P. Charlton.2009
2_Journal of Intensive Care Medicine
The Author(s) 2016
Reprints and permission:
sagepub.com/journalsPermissions.nav
3-Medically reviewed by Dena Westphalen, PharmD on January 24,
2018 — Written by Jacquelyn Cafasso.
4-Altschul E, Grossman C, Doughtery R, et al. Lithium Toxicity: A
Review of Pathophysiology, Treatment, and Prognosis. Practical
Neurology. March 2016:42–45.