Mood Stabilizers

Side effects: 

Lithium carbonate is generally well-tolerated when used as a mood stabilizer for the treatment of bipolar disorder. However, like any medication, it can cause side effects, both in the short term and the long term.

Short-term side effects of lithium can include:

• Nausea, vomiting, and diarrhea
• Dry mouth and thirst
• Increased urination
• Muscle weakness and tremors
• Fatigue and drowsiness
• Headaches
• Increased appetite and weight gain
• Mild cognitive impairment (difficulty with attention, memory, or problem-solving)
• Skin rash or acne
• Vertigo.
• Dysarthria (impaired articulation of speech).
• Cardiac arrhythmias.
• In some patients they may have oedema.
• Nystagmus

Many of these side effects are usually mild and may resolve on their own as the body adjusts to the medication. Some people may be able to manage these side effects by adjusting the dosage or timing of their medication, or by taking it with food or milk.

Long-term use of lithium can cause more serious side effects, including:

• Kidney damage or kidney failure
• Hypothyroidism (underactive thyroid gland)
• Increased risk of diabetes mellitus
• Cardiovascular disease (heart disease)
• Neurological effects (such as hand tremors, slurred speech, and impaired coordination)
• Teratogenicity (birth defects in fetuses exposed to lithium during pregnancy)
• Hypothyroidism i.e. reduced thyroxin in the body as lithium carbonate interferes with metabolism
• Nephrogenic diabetes insipidus   
• Depletion of calcium in bones 
• Memory impairment affects memory centers of the brain.

NB: Big doses of neuroleptics e.g. haloperidol when used together with lithium for a long time may cause irreversible toxic encephalopathy.

Management of lithium toxicity

The following are some general principles for managing lithium toxicity:

1. Stop taking lithium: The person should stop taking lithium immediately to prevent further toxicity.

2. Fluid and electrolyte replacement: Intravenous fluids may be given to help flush out the excess lithium from the body and to restore electrolyte balance.

3. Supportive care: The person may need to be hospitalized for close monitoring of their vital signs and mental status. In severe cases, mechanical ventilation and dialysis may be necessary.

4. Pharmacological treatment: Depending on the severity of the symptoms, the person may be given medications to help control nausea, vomiting, seizures, or other symptoms.

Continue;

• Assess serum lithium levels, serum electrolytes, renal functions, ECG as soon as possible.
• Maintenance of fluid and electrolyte balance 
•  In a patient with serious manifestations of lithium toxicity, hemodialysis should be initiated.
•  For significant short time ingestions, residual gastric content should be removed by induction of emesis, gastric lavage  and adsorption with activated charcoal
• If possible instruct the patient to ingest fluids

NURSE’S RESPONSIBILITIES FOR PATIENT RECEIVING LITHIUM

1. Assessment: Nurses should perform a thorough assessment of the patient before starting lithium treatment, including a physical examination, medical history, and laboratory tests to establish baseline values. Nurses should also monitor the patient regularly for potential side effects or adverse reactions.

2. Education: Nurses should educate the patient and their family members about the proper use of lithium, including the dosage, timing, and potential side effects. They should also instruct the patient to avoid dehydration and to maintain a consistent level of sodium intake.

3. Medication administration: Nurses should administer lithium carbonate according to the prescribed dosage and timing. They should also monitor the patient’s compliance with the medication regimen and report any missed doses or concerns to the healthcare provider.

4. Monitoring: Nurses should monitor the patient regularly for potential side effects or adverse reactions, such as tremors, confusion, or kidney dysfunction. They should also monitor the patient’s blood levels of lithium, electrolytes, and kidney function regularly and report any abnormalities to the healthcare provider.

5. Collaboration: Nurses should collaborate with the healthcare provider and other members of the healthcare team to ensure the safe and effective use of lithium carbonate. They should also communicate any concerns or changes in the patient’s condition to the healthcare provider in a timely manner.

6. The pre-lithium work up: A complete physical history, ECG, blood studies (FBS, creatinine, electrolytes) urine examination (routine and microscopic) must be carried out. It is important to assess renal function as renal side effects are common and the drug can be dangerous in an individual with compromised kidney function. Thyroid functions should also be assessed, as the drug is known to depress the thyroid gland.

Precautions

To achieve therapeutic effect and prevent lithium toxicity, the following precautions should be taken:

• Lithium must be taken on regular basis, preferably at the same time daily. For example, a client taking lithium on TID schedule, who forgets a dose, should wait until the next scheduled time to take lithium and not take twice the amount at one time, because lithium toxicity can occur.
• When lithium therapy is initiated, mild side effects such as fine tremors, increased thirst and urination, nausea, anorexia etc may develop. 
• Serious side effects of lithium that necessitate its discontinuance include vomiting, extreme hand tremors, sedation, muscle weakness and vertigo. The psychiatrist should be notified immediately if any of these effects occur.
• Since polyurea can lead to dehydration with risk of lithium intoxication, patients should advised to drink water to compensate for the fluid loss
• Various situations can require an adjustment in the amount of lithium administered to a client, such as the addition of a new medicine to the client’s drug regimen, a new diet or an illness with fever or excessive sweating. People involved in heavy outdoor labor are prone to excessive sweating sodium loss through sweating. Must be advised to consume large quantities of water with water with salt, to prevent lithium toxicity due to decreased sodium levels.
• Frequent serum lithium level evaluation is important. Blood for determination of lithium levels should be drawn in the morning approximately 12-14 hours after the last dose was taken.
• The patient should be told about the importance of regular follow up. In every six months, blood sample should be taken for estimation of electrolytes, urea, creatinine, a full blood count, and thyroid function test.