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What is the mechanism of action of lithium?
MOA is unknown but it may modulate serotonin and cuase serotonin syndrome when added with other medications
What defines an acute ingestion of lithium? and where in the body does it distribute in this case?
Acute means they have never been on Lithium and it's a single acute ingestion.
There is less buildup of lithium in the tissues, it has not equilibrated, higher levels in the blood.--> hemodialysis
what defines an acute/chronic ingestion of lithium? where does it distribute?
Acute/chronic ingestion is when a patient is regularly on lithium but takes a large acute dose of lithium
Distribution: there is build up of lithium in the tissues, so there is more lithium and there is also a great amount of it that that has not equilibrated--> still hemodilyzeable
what defines a chornic lithium toxicity? where is lithium distributed?
Chronic toxicity happens when patient is taking too much lithium in the long-term or the patient develops acute renal injury and is on lithium
Distribution: lithium already in the tissues built-up. Hemodialysis can work but data does not really show that its very effective. People may dialyze especially if patient showing signs of great toxicity
what is the volume of distribution of lithium?
Vd <1 so it is hemodialyzable, however that is deceiving since lithium goes wherever sodium goes.
what are symptoms of lithium toxicity?
-Nausea and vomity
-CNS: seizures, fine tremor, myoclonus, fasciculatins, rigidity
-Renal: diabetes insipidus possible
what is the importance of obtaining lithium levels in determining severity of toxicity?
monitoring the trend of lithium levels is helpful in knowing if treatment is working. However, the actual value is not very good indicator of severity of toxicity because patients on chronic lithium have built up lithium that is not reflected in the blood (there's lots in the tissues).
what is the treatent for lithium over dose?
1. dialysis (3-4 times may be necessary due to equilibration of lithium between blood and tissues)
3. furosemide does not work
4. monitor levels every 4-6 hours
why are we concerned with lithium overdose?
becuase of SILENT syndrome: an irreversable type of Parkinson's demetia
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