Educational use only. Drug cards are AI-assisted study material for NCLEX preparation.
Lithium carbonate (Lithobid, Eskalith)
Mechanism of action
Mechanism is incompletely understood — likely modulates second-messenger systems (PIP2/IP3 and cAMP) and neurotransmitter release. The empiric effect: dampens manic and depressive episodes in bipolar disorder and reduces suicide risk. Used for bipolar I and II maintenance, acute mania (slow onset, often bridged with an antipsychotic), and treatment-resistant depression augmentation.
Adverse effects
Life-threatening / NCLEX-tested
- Lithium toxicity — life-threatening; therapeutic 0.6–1.2 mEq/L; > 1.5 is toxic; > 2.0 is severe; > 2.5 is a medical emergency
- Nephrogenic diabetes insipidus (polyuria, polydipsia, dehydration)
- Chronic kidney disease with long-term use
- Hypothyroidism (and rarely hyperthyroidism) — TSH rises
- Seizures, coma, arrhythmias (severe toxicity)
- Teratogenic — Ebstein's anomaly with first-trimester exposure
Side effects
Common — what to teach
- Fine hand tremor (coarse tremor signals toxicity)
- Polyuria, polydipsia
- Weight gain
- GI upset, nausea, mild diarrhea
- Mild cognitive slowing, memory complaints
- Acne and psoriasis flare
Food & drug interactions
ANY drug or condition that lowers sodium or volume RAISES lithium — thiazide diuretics, ACE inhibitors, ARBs, NSAIDs, low-sodium diet, dehydration, vomiting, diarrhea, fever, sweating. Loop diuretics also raise levels (less than thiazides). Carbamazepine + lithium can cause neurotoxicity at therapeutic levels. Caffeine slightly lowers levels.
Nursing implications
Assessment, monitoring, patient teaching
- Check lithium level 12 hours after the last dose, weekly during titration, then every 3–6 months once stable; baseline and ongoing TSH and renal function (BUN/Cr/eGFR)
- Teach early toxicity signs: coarse tremor, GI upset, ataxia, slurred speech, confusion — STOP and call
- Maintain consistent salt and fluid intake (about 2–3 L/day); illness, fever, dehydration, and crash diets are toxicity triggers
- AVOID NSAIDs unless approved by the prescriber; acetaminophen is a safer OTC pain choice
- Counsel about pregnancy risk; avoid in the first trimester
- Therapeutic effect for mania takes 1–3 weeks; antipsychotic bridging is often used acutely
- Two-nurse verification for inpatient doses — high-alert medication
When to hold / contraindications
- Suspected lithium toxicity (level > 1.5 with symptoms, or any level with severe symptoms)
- Acute illness with significant volume loss (vomiting, diarrhea, fever, profuse sweating)
- New AKI or significant rise in creatinine
- Initiation of a known interacting drug (NSAID, thiazide) without dose review
- Pregnancy (especially first trimester) without explicit psychiatric direction
Memory anchor
Lithium 0.6–1.2 mEq/L therapeutic; 1.5 toxic; 2.5 emergency. Sodium and volume protect; NSAIDs, dehydration, and diuretics push you over the edge.
Practice Lithium questions
Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.