Lithium in afya

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mood stabilising drug 
prophylatically in bipolar disorder and as adjunct in refractory depression
narrow therapeutic range (0.4-1.0 mmol/L) and a long plasma half-life (excreted by kidneys)

''Adverse effects'' (Lithium - Lethwn)
L - polyuria (secondary to nephrogenic diabetes insipidus)
e - ECG: T wave flattening/inversion
t - fine tremor
h - thyroid enlargement, may lead to hypothyroidism
w - weight gain
n - nausea/vomiting, diarrhoea

''Monitoring''
inadequate monitoring common 
lithium blood level  3 months -  12 hours post-dose
thyroid and renal function  every 6 months
patients should be issued with an information booklet, alert card and record book

''Lithium toxicity'' occurs if > 1.5 mmol/L.
may be precipitated by dehydration, renal failure, diuretics (especially bendroflumethiazide), ACE inhibitors and metronidazole.

''Features of toxicity''
    coarse tremor (a fine tremor is seen in therapeutic levels)
    acute confusion
    seizure
    coma

''Management''
    mild-moderate toxicity may respond to volume resuscitation with normal saline
    haemodialysis may be needed in severe toxicity
    ?sodium bicarbonate (limited evidence - increasing urine alkalinity promotes lithium excretion?)
?aminophylline reduces lithium plasma concentration

Mechanism of action - not fully understood, two theories:
interferes with inositol triphosphate formation
interferes with cAMP formation

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