Lithium (MRCPsych course)

 MRCPsych course

Adverse Effects Of Lithium

Early lithium adverse effects:

4 T’s:

• Thirsty
• Tired
• Tremor (fine)
• Taste (metallic)

Long term lithium adverse effects:

•  Diabetic insipidus
•  Hypothyroidism
•  Hyperparathyroidism
•  Weight gain
•  Coarsening & Hair loss
•  Leucocytosis
•  Hypokalaemia ( maybe associated with arrhythmias & T wave flattening (ECG)

Toxic ( >1.5 mmol/l)

CAT Got your tongue, ears & eyes

• Cerebellar syndrome *(refer below)
• Anorexia
• Tremor (Coarse)
• Gut/ GIT symptoms (diarrhoea, vomiting)
• Tongue – dysarthria
• Ears – tinnitus
• Eyes – Blurred vision

         Hyperreflexia

*Cerebellar syndrome

VANISHED

• Vertigo
• Ataxia
• Nystagmus
• Intentional tremor
• Speech staccato
• H
• Exaggerated broad-based gait
• Dysdiadokinesia

Extreme toxicity (>2.5 mmol/l)

6 C’s:

• Confusion
• Convulsion
• Circulatory failure
• Collapse
• Coma
• Corpse (death)

Teratogenicity : (especially use during 1^st trimester)- Ebstein’s anomaly

Factors that can lead to Dangerous toxicity:

4D’s

• Diuretics
• Dietary Deficiency of Na+
• Dehydration
• Drugs :

o   NSAIDs,

o   Acetazolamide

o    Metronidazole (high risk of Li+ toxicity during co-administration & for up to 3 weeks afterwards)

o   High doses haloperidol (>20mg/day)

 MRCPsych course