Lithium

INTRODUCTION

Indications

Manic episodes of manic depressive illness (treatment, maintenance, prophylaxis).

Action

Alters cation transport in nerve and muscle. May also influence reuptake of neurotransmitters. Therapeutic Effects: Prevents/decreases incidence of acute manic episodes.

Adverse Reactions/Side Effects

CNS: SEIZURES, fatigue, headache, impaired memory, ataxia, sedation, confusion, dizziness, drowsiness, psychomotor retardation, restlessness, stupor. EENT: aphasia, blurred vision, dysarthria, tinnitus. CV: ARRHYTHMIAS, ECG changes, edema, hypotension. GI: abdominal pain, anorexia, bloating, diarrhea, nausea, dry mouth, metallic taste. GU: polyuria, glycosuria, nephrogenic diabetes insipidus, renal toxicity. Derm: acneiform eruption, folliculitis, alopecia, diminished sensation, pruritus. Endo: hypothyroidism, goiter, hyperglycemia, hyperthyroidism. F and E: hyponatremia. Hemat: leukocytosis. Metab: weight gain. MS: muscle weakness, hyperirritability, rigidity. Neuro: tremors.

PHYSICAL THERAPY IMPLICATIONS

Note: Many symptoms listed below may indicate lithium toxicity. Mild toxicity is associated with metallic taste, fine tremor, nausea, and weakness. Moderate levels include vomiting, diarrhea, increased tremor, dizziness, incoordination, and blurred vision. Severe lithium toxicity is associated with confusion, hallucinations, nystagmus, dysarthria, and fasciculations. Be alert for these symptoms, and notify the physician about any increase in the signs of lithium toxicity.

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment or following an increase in dose. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report arrhythmias or symptoms of rhythm disturbances, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor personality and behavioral changes such as restlessness, confusion, impaired memory, mental slowness, and stupor. Notify physician if these changes become problematic.

• Assess any muscle weakness, rigidity, or other changes in muscle tone and excitability. Try to determine if symptoms are drug induced rather than caused by neurologic or musculoskeletal pathology.

• Monitor and report any increase or decrease in metabolism that might indicate thyroid disorders. Signs of hyperthyroidism include tachycardia, nervousness, heat intolerance, weight loss, muscle wasting, and goiter. Hypothyroidism is typically indicated by bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness.

• Watch for signs of hyperglycemia such as drowsiness, fruity breath, increased urination, and ...