Lithium — monitoring
Narrow therapeutic index. Blood level drawn 12 hours after the last dose. Early toxicity: coarse hand tremor, nausea, vomiting, diarrhea, drowsiness. Severe toxicity: ataxia, slurred speech, confusion, seizures, arrhythmia. What raises the level: dehydration, sodium loss, vomiting, diarrhea, sweating, fever, low-salt diet, NSAIDs, thiazide diuretics, ACE inhibitors. Teaching: steady salt and fluid intake, report vomiting or diarrhea, never stop abruptly, keep the scheduled blood work.