Case study 2.4

Question 1

What blood tests need to be taken before starting a patient on lithium?

Answer 1

renal function
thyroid function
calcium levels
ECG levels

Question 2

Why should thyroid function be taken before starting a patient on lithium?

Answer 2

Lithium is a small molecule that mimics the thyroid hormone

This reduces the amount of thyroid that is produced

This is known as hypothyroidism

Question 3

What are the symptoms of hypothyroidism?

Answer 3

Tiredness
Weight gain
Depression
Muscle ache
Dry skin and hair
Sensitive to the cold

Question 4

How would you start a patient on lithium?

Answer 4

Dose is calculated per weight

Titrate up depending on the levels we get back after 12 hrs

Would use a lower dose if patient has renal function issues

Question 5

What are the symptoms of lithium toxicity?

Answer 5

Drowsiness
Comma
Seizures
confusion
Tremor
visual disturbances

Question 6

What are the key counselling points to give to patients who are on lithium?

Answer 6

• Always carry your lithium card
• Advice on signs of toxicity
  -Regular blood tests should be taken especially at the start of treatment to find out if dose is effective

Question 7

“Patients who are on ramipril should be monitored more closely” Why is this the case?

Answer 7

Ramapril increases levels of lithium within the blood

This is because it increases sodium levels, therefore lithium is not renal cleared as well

Question 8

Can you stop taking lithium abruptly ?

Answer 8

no, contact psychiatrist