- Lithium
- Uses
- Mania
- BAD
- Recurrent depression
- Chronic cluster headache
- Neuropathic pain
- Central pain syndromes
- Clinical measurement
- 0.075-0.3 mmol is injected for Li dilution measurement and has no clinical effect
- CI in pregnancy 1st trimester
- Narrow therapeutic window 0.5-1.0mmol/L, toxic over 1.5mmol/L
- Mechanism of action
- Unknown
- Increases NA by presynaptic membranes and increases its metabolism
- Also inhibits cAMP signalling
- Pharmacokinetics
- 100% bioavailabilty
- Peak plasma effects at 1-4hrs
- Vd ~ TBW
- Not protein bound
- Excreted via the kidneys
- Half oral dose excreted by 12 hrs
- Li and anaesthesia
- Prolonged NMBDs
- Conduction defects
- Omit for 24 hrs prior to anaesthesia
- Pregnancy increases clearance
- Pre-eclampsia may precipitate toxicity
- Can cause fetal abnormalities (Ebstein's)
- Discuss with psychiatrists
- Management of toxicity
- Supportive
- Dialysis
- Neuro symptoms
- Li level over 7.5mmol/L
- > 4 in acute on chronic OD
- Side effects
- DI
- Hypothyroidism
- Goitre
- N&V
- Diarrhoea
- Blurred vision
- Nystagmus
- Hyper-reflexia
- Convulsion, coma, death
- CEACCP
Link:ceaccp.oxfordjournals.org/content/10/3/77.full.pdf?sid=be332444-0128-4321-abe3-18295731c7c8