Therapeutic lithium levels are typically 0.6-1.2 mEq/L for maintenance therapy and 0.8-1.2 mEq/L for acute mania treatment. Levels must be checked: 5-7 days after initiation or dose change; then every 3-6 months when stable; and more frequently with illness, dosage changes, or signs of toxicity. Blood should be drawn 12 hours after last dose (trough level). Levels 1.5-2.0 mEq/L indicate mild to moderate toxicity; >2.0 mEq/L severe toxicity potentially fatal. Factors affecting levels: sodium intake (low sodium increases retention); dehydration; NSAIDs; diuretics; ACE inhibitors; and renal impairment. Nurses educate patients about: maintaining consistent salt and fluid intake; recognizing early toxicity (nausea, tremor, diarrhea, drowsiness); avoiding OTC medications without consultation; regular monitoring; and not stopping abruptly. Other monitoring: renal function (creatinine, BUN); thyroid function (TSH); ECG if indicated; and weight. Lithium has narrow therapeutic index requiring careful management.

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Zambia

• Joseph Soko – 101 pts

• Visual Pathway Lesions
• Positive and Negative Symptoms
• Hallucinations and Delusions
• Antipsychotic Medications
• Emergency: Environmental Emergencies