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Monitoring lithium levels (see Lithium Standards)
Causes of toxicity
Signs of toxicity
All patients on lithium will have safe use of the drug identified as a need in their care plan. The following elements should be considered
Preventing & managing toxicity
Communication of information at transition points e.g. discharge
Patient and carer education
Consider the pertinent elements of the checklist at each MDT meeting
|Pre- treatment checks||ECG (if clinically indicated), U&Es, renal function, thyroid function, weight.|
|Medicines reconciliation||Has the correct dose and brand been identified on admission?|
|Prescribed correctly on the prescription sheet?||Both brand and approved name e.g. PRIADEL (Lithium Carbonate)|
|Review potential drug interactions||Prescription reviewed for relevant drug interactions|
Has appropriate education been provided to patients, carers and staff?
|Lithium level monitoring||Is there a clear plan in place for monitoring lithium levels?|
|Care planning||Does the care plan include lithium as a need?|
|Side effect monitoring||Is there a systematic plan in place to monitor and report side effects?|
|Lithium clinical factors considered||Are relevant clinical factors being considered before lithium is administered?|
|Physical health||Are the patients physical health needs being monitored and addressed?|
|Discharge/transfer plan||Is there a clear discharge/transfer plan in place?|
Nurses should consider the following factors before giving a dose of lithium.
In the last 24 hours has the patient experienced any of the following
If yes seek medical advice before giving the dose.
1Thiazide diuretics, other diuretics (furosemide, spironolactone), NSAIDs (ibuprofen), ACE inhibitors (e.g. ramipril), angiotensin-2 receptor antagonists (e.g. candesartan).
Last reviewed: 31 May 2019
Next review: 01 July 2021
Author(s): Lithium Short Life Working Group
Approved By: Prescribing Management Group - Mental Health
Reviewer Name(s): Andrew Walker, Suzanne Burke