Lithium


Lithium


  • Monovalent cation and get rapidly and completely absorbed after oral administration
  • t1/2 – 1.3 days but increased to 2.4 days after continued TT for more than 1 year
  • Not metabolized in body and excreted unchanged in kidney

Indications:

  • Acute Manic Episode
  • Schizoaffective Ds
  • Bipolar Depression
  • OCD
  • Gout
  • Epilepsy
  • Maintenance Therapy
  • Cluster migraine
  • Ulcerative Colitis

Narrow therapeutic index Acute Mania [1.0-1.5 meq/dL] and maintenance [0.6-1.2 meq/dL]

Neurological Side Effect Postural tremors [T/T Propranolol], Lack of spontaneity, decreased memory, ↑ ICT and peripheral neuropathy

Endocrine – Hypothyroidism [Rarely hyperthyroidism]

Renal – Polyuria may lead to diabetes insipidus, Rarely Nephrotic Syndrome, RTA & Intestinal fibrosis
Others – Acne, Psoriasis, Nausea, vomiting, diarrhea, weight gain, Benign T wave change

Lithium Toxicity:

  • Risk Factors – Renal impairment, dehydration and Low sodium diet
  • Earliest symptoms – GI Symptoms [Abdominal pain, vomiting] followed by neurological symptoms like coarse tremors, ataxia and dysarthria.
  • Late Symptoms – Impairment of consciousness, muscular fasciculation’s, ↑ DTR, Convulsions, Circulatory Failure
  • Management – Stop Lithium. Correct Dehydration, Polyethylene Glycol Gastric lavage & hemodialysis

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