Lithium Nursing Considerations [Interventions & Implications]

If you have ever heard of Lithium and wondered how it works, this post is for you. Here we will explain everything there is to know about the drug, its use, its side effects, and more. We’ll cover why Lithium is such an essential medication for those with manic depression and provide a few tips for managing its use if you are prescribed it. Read on to find out all about these powerful yet somewhat enigmatic drugs.

Introduction of Lithium Drugs

Lithium is a chemical element that has become one of the go-to treatments for mental health issues such as depression and bipolar disorder. It’s also attracted much attention due to its broad consumer use, ranging from therapeutic electric batteries to medication used in modern medical practices.

Although Lithium is widely recognized as an essential aspect of mental healthcare, it isn’t well understood by many outside of the medical profession.


Lithium is a medication that belongs to the class of mood stabilizers. It affects the balance of chemicals in the brain, which can help reduce symptoms like mania or depression associated with bipolar disorder and other mental health conditions. It is commonly prescribed to treat mental health conditions such as bipolar disorder, depression, and schizophrenia.

Uses of Lithium Drugs

Lithium is used to help stabilize moods and reduce symptoms associated with bipolar disorder, depression, and other mental health conditions. It is thought to do so by affecting the balance of chemicals in the brain.

The most common use for lithium is to treat manic episodes associated with bipolar disorder. However, it can also be prescribed off-label for other mental health conditions such as depression, anxiety disorders, aggression-related issues, or even schizophrenia. Additionally, some studies have suggested that lithium may be beneficial in treating alcohol addiction and dementia.

Dosage & Route


  • Acute mania: Administer 600 mg orally thrice daily or 900 mg of the slow-release form twice daily to achieve adequate serum levels ranging from 1 to 1.5 mEq/L. It is recommended to check the serum levels twice weekly by taking samples immediately before dosing (at least 8–12 hours after the previous dose).
  • Long-term use: Take 300 mg orally three to four times daily to reach a serum level of 0.6–1.2 mEq/L. Serum levels should be monitored every two months, with samples taken right before medication (at least 8–12 hours post the last dose).
  • Conversion from conventional to slow-release dosage forms: Maintain the same daily dose, and divide it into two or three doses.

Pediatric Patients

Safety and efficacy for children < 12 yr not established.

Geriatric Patients And Patients With Renal Impairment

For elderly patients, the dosage might require adjustment as their bodies may not tolerate levels of this medication that other patients can handle. Additionally, this medication has a longer half-life in those with kidney impairment. Therefore, reduced dosages may be needed for these people too.

Therapeutic actions

The exact way lithium works are not fully understood, yet it appears to modify the intraneuronal metabolism of neurotransmitters such as catecholamines and sodium transportation within neurons and muscle cells.

Side Effects of Lithium Drugs

Like all medications, there are potential side effects accompanying using Lithium. These can include nausea, vomiting, diarrhea, dizziness, tremors, skin rash, increased thirst and urination, muscle weakness or stiffness, weight gain or loss. Speaking with your doctor about any potential side effects you may experience while taking Lithium is essential.

What are the symptoms of lithium toxicity?

Lithium drugs’ toxicity and severity depend on how much lithium is in your blood.

Mild to Moderate Toxicity Severe Toxicity

(Lithium above 2.0 mEq/Ldiarrhea)

Side effects in lower doses
diarrhea heightened reflexes frequent urination
vomiting seizures thirst
stomach pains agitation hand tremors
fatigue slurred speech dry mouth
tremors kidney failure weight gain or loss
uncontrollable movements rapid heartbeat gas or indigestion
muscle weakness hyperthermia restlessness
drowsiness uncontrollable eye movements constipation
weakness low blood pressure rash

Risks of Taking Lithium Drugs

When taken as prescribed by a physician, the risk of adverse reactions from lithium is low. That said, certain cautions should be observed when taking this medication. For example, patients with kidney problems should consult with their physician before starting lithium therapy due to the possibility of kidney damage. In addition, overuse of lithium can lead to an overdose which can be dangerous and even fatal in severe cases.

Lithium Nursing Considerations


  • History: Individuals who have a hypersensitivity to tartrazine, those with serious renal or cardiovascular disease, those in a state of severe debilitation and dehydration, individuals on diuretics, people experiencing extended sweating and diarrhea, patients who are suicidal or impulsive, those suffering from fever due to infection and pregnant/lactating women should be closely monitored.
  • Physical: Monitor the patient’s weight, temperature, skin color and lesions, level of orientation and affect, reflexes, ophthalmic examination of eyes, pulse rate, blood pressure, respiration, and any adventitious sounds. Furthermore, assess the presence/absence of bowel sounds, normal input/output fluid levels, and voiding pattern. Additionally, conduct tests to measure thyroid, renal glomerular, tubular function, urinalysis, and complete blood count with differential and baseline ECG.

Lithium Toxicity Nursing Interventions

Due to the narrow therapeutic window of lithium, it is essential to take caution not to reach toxic levels. Regular monitoring of lithium levels is necessary, and medications that could increase these levels must be avoided. These include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
  • Diuretics or water pills
  • ACE inhibitors or angiotensin receptor blockers used to treat high blood pressure
  • Certain antibiotics, such as amoxicillin or cephalexin
  • Certain steroids, including prednisone
  • Certain antidepressants, including monoamine oxidase inhibitors

Your patient should also avoid drinking alcohol or using street drugs while taking lithium. These substances can all make the effects of lithium more severe and increase the risk of toxicity.

Lithium Dosage Adjustments

Lithium levels should be monitored regularly, and your patient’s dose may need to be adjusted based on these levels. If your patient’s lithium level is too high or too low, their dose should be adjusted accordingly.

It is important to note that adjusting the dose of lithium can take some time. It can take several weeks for a new dosage level to reach a steady state in the blood and for any new side effects to be noticed. Patients should not stop taking lithium if any new side effect appears but instead should contact their healthcare provider, who can adjust the dose as needed.

Patients should also be aware that dosage adjustments may need to occur more frequently during times of stress or illness. Your patient’s healthcare provider will likely advise them on how to adjust their dose of lithium during these times.

Monitoring for Adverse Effects

Patients taking lithium should be monitored closely for adverse effects, including changes in behavior or mood, dizziness, nausea or vomiting, trembling or jerking movements, abdominal pain, and diarrhea. If your patient experiences any of these symptoms while taking lithium, they should contact their healthcare provider for further evaluation and possible dose adjustment.

Patients taking lithium should also be monitored closely for signs of kidney damage, including an elevated creatinine level in the blood or white cells in their urine. If these symptoms are present, patients should contact their healthcare provider immediately.

Finally, pregnant women taking lithium should be monitored closely during pregnancy and the postpartum period to ensure they are getting the correct dose of the medication. Women taking lithium should also be monitored closely for any signs of fetal distress or adverse effects on the baby.

Lithium Patient Teaching

  • Take this medication as directed, with meals or with food or milk. Swallow extended-release tablets whole; do not chew or crush.
  • Eat a balanced diet and regularly intake salt and fluids (at least 2.5 quarts/day).
  • Regularly attend scheduled checkups and have blood tests done as instructed. This helps you to get the most out of your treatment with the least risk of side effects.
  • Use contraception to avoid pregnancy. If you are pregnant, speak to your healthcare provider immediately.
  • Discontinue this medication and contact your doctor if any adverse effects such as diarrhea, vomiting, ataxia, tremor, drowsiness, lack of coordination or muscular weakness occur.
  • You may also experience some mild side effects such as drowsiness, dizziness (avoid driving or performing tasks requiring alertness); GI upset (eat frequent small meals), slight thirst and increased urine output; fine hand tremor (may persist throughout therapy; talk to your health care provider if it becomes severe).
  • Report any cases of diarrhea or fever to your healthcare provider.

Tips for Managing Lithium Drugs Use:

1. Follow your doctor’s directions exactly as prescribed; do not increase or decrease your dose without consulting with them first.

2. Take regular blood tests to measure your lithium levels; this will help you and your physician ensure that your medication is at an optimal therapeutic level.

3. Avoid alcohol and other drugs that may interact with lithium, as these can increase its side effects or reduce its effectiveness.

4. Regular check-ups with your doctor to monitor your physical and mental health; this will help catch any potential problems early on and ensure that you remain in good health while taking lithium.

5. Speak openly with your doctor about any concerns related to your medication; they can provide reassurance and support throughout the treatment process.

6. Educate yourself on the risks associated with lithium use so that you know what to look out for and how to address any problems should they arise.

7. Remember that it may take several weeks for the full effects of lithium to become apparent; do not be discouraged if you do not see immediate results.

8. Remain consistent with your medication schedule and follow up with your doctor regularly; this will help ensure you stay on track and get the most out of your treatment.

9. Do not stop taking lithium suddenly without consulting a medical professional; sudden discontinuation of lithium can lead to serious health risks.

10. Ask for help if you are feeling overwhelmed or having difficulty managing your medication use. Many resources are available to help people with mental illness stay in control of their lives and manage their treatment.



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