Question

A client who takes lithium is admitted to the mental health unit for suicidal aviation’s. The nurse that shares the clients serum lithium level results of 1.5 meq/L (1.5mmol/L) with the client who becomes very anxious, asking the nurse what to do. Which action should the nurse implement?

    A. Instruct the client to drink 3 L of fluid for 24 hours

    B. Encourage client to eat a low sodium diet

    C. Ask the healthcare provider if hemodialysis is needed

    D. Tell the client to move about and increase his activity

Answer 1

A. Instruct the client to drink 3 L of fluid for 24 hours

This is the right option that should be followed by the nurse in the patient care of over coming lithium toxic condition. The reason to ask the patient to increase the fluid intake because , the dehydration might cause increase in the lithium toxicity due to the absorption of lithium from kidney. The bio availability of lithium is almost 100 % . This results in rapid absorbtion of lithium in the case of dehydrated patient status. Therefore inorder to prevent the absorbtion of more lithium from renal system is done by increasing hydration. The dehydration might be caused due to the diabetes insipidus in case of toxicity of lithium. It is prevented by increasing oral fluid intake and maintaing the fluid balance.

The rest of the options are rejected because of the following reasons:

B) Encourage client to eat a low sodium diet

This statement is rejected because the patient should be provided with the sodium balance. The low sodium diet will cause hyponatremia. In this decreased sodium condition it will results in increase of lithium reabsorption in proximal tubules.The kidneys treat lithium and sodium similarly which is the reason sodium depletion can significantly elevate lithium reabsorption. So intake of sodium is very important and must be increased.

C) Ask the healthcare provider if hemodialysis is needed. This option is rejected because this is only done in the acute severe conditions of lithium toxicity.

Lithium toxicity can be divided into 3 mild moderate and severe conditions. Here the patients serum lithium level is 1.5 mmol/L this is a mild toxic condition. And the hemodialysis is not recommended in mild toxic situations.

D)Tell the client to move about and increase his activity

This option is rejected because the toxic conditions will cause dehydration in the patient results in lethargy. If the patient improves the activity it increases the sweating and further dehydration will be occured. Therfore the patient is recommended for tsking rest and also to be monitored for sighns and symptoms of toxicity.