8. Lithium Toxicity

Patient Prompts

  • The daughter reports: "Dad has been increasingly confused over the past few days, and now he hasn’t urinated for a whole day. He’s also been skipping his Lithium blood tests."
  • She expresses concern about his non-adherence to follow-up appointments and possible side effects of his medication.

Scenario Clinchers

  • The patient's confusion and urinary retention, combined with a history of Lithium use, raise concerns for Lithium toxicity, especially in the context of inadequate monitoring.
  • The absence of recent Lithium level monitoring and the patient’s erratic behavior suggest the need for urgent assessment.

Patient Concerns

  • The daughter is worried about the immediate health risks to her father and the long-term implications of his current state on his overall well-being.
  • She is anxious about the possibility of Lithium toxicity and its potential consequences.

Clinchers and Important Points for the Doctors

  • Recognize the signs that could indicate Lithium toxicity, including neurological symptoms (confusion, tremors), renal issues (urinary retention), and the need for immediate intervention.
  • Understand the importance of collateral history in assessing patients with psychiatric disorders, especially when they may be unable to provide accurate information due to their condition.

What Is Expected from the Doctor

  • Conduct a thorough clinical assessment, including mental status examination, neurological evaluation, and assessment for signs of urinary retention.
  • Immediate ordering of relevant investigations, including serum Lithium level, renal function tests, electrolytes, and ECG to assess for Lithium toxicity and its complications.
  • Initiate appropriate management for suspected Lithium toxicity, which may include stopping Lithium, ensuring adequate hydration, and considering the need for dialysis based on the Lithium level and clinical status.

Red Flags

  • Acute confusion and urinary retention in a patient on Lithium therapy are red flags for potential Lithium toxicity, which can lead to severe complications if not promptly addressed.
  • Signs of renal impairment or altered mental status require immediate medical attention and possibly urgent intervention.

Actions Doctor Should Do

  • Ensure the patient is stabilized, manage acute symptoms, and address immediate life-threatening complications of suspected Lithium toxicity.
  • Consult with a psychiatrist for management of his bipolar disorder and to discuss alternative treatments given the current situation.
  • Involve a multidisciplinary team, including urology, psychiatry, and nephrology, as appropriate, for comprehensive care.

Referral Needs

  • Immediate referral to nephrology if there is evidence of renal impairment or if dialysis is considered.
  • Psychiatry consultation for managing his bipolar disorder in the context of current medical issues and re-evaluation of his Lithium therapy.

Reason for Referral

  • Nephrology input is crucial for managing potential Lithium-induced nephrogenic diabetes insipidus or acute kidney injury.
  • Psychiatry expertise is needed to adjust or change his psychiatric medication, ensuring his mental health is managed safely and effectively, especially in light of the current crisis.
Other Drugs Causing Urinary Retention

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