Diarrhoea lithium

Adverse reactions that are not dose dependent are nausea, vomiting and diarrhoea. Lithium has a low therapeutic index. Some adverse reactions such as thirst and mild polyuria may occur at therapeutic plasma concentrations of 0.4-1.0 mEq/1. At concentrations of 1.0-1.6 mEq/1 diarrhea, nausea and incoordination become prominent. At toxic levels ataxia, confusion and stupor occur potentially leading to coma and death. 

Lithium salts, generally in the form of the carbonate or bicarbonate, are rapidly absorbed from the gastrointestinal tract and reach a peak plasma concentration after 2- hours. Extreme fluctuations in blood lithium levels, which are associated with side effects such as nausea, diarrhoea and abdominal cramp, are reduced by using sustained release preparations. Lithium is not protein bound and therefore is widely distributed throughout the body water, which accounts for the adverse effects it has on most organ systems should it reach toxic levels. To avoid toxicity, and ensure optimal... 

Pharmaceutics. It is important for any patient to adhere to the same pharmaceutical brand, as the dose of lithium ion (Li ) delivered by each tablet depends on the pharmaceutical preparation. For example, each Camcolit 250 mg tablet contains 6.8 mmol, each Liskonium 450 mg tablet contains 12.2 mmol and each Priadel 200 mg tablet contains 5.4 mmol of Li . Thus the proprietary name must be stated on the prescription. Some patients caimot tolerate slow-release preparations because release of lithium ions distally in the intestine causes diarrhoea they may be better served by the liquid preparation, lithium citrate, which is absorbed proximally. Patients who are naive to lithium should be started at the lowest dose of the preparation selected. Any change in preparation demands the same precautions as does initiation of therapy. 

Magnesium-containing antacids may also produce diarrhoea, as may NSAIDs and lithium. 

Toxic effects of lithium can be fatal. Early signs of lithium toxicity are vomiting and severe diarrhoea followed by tremor, ataxia, renal impairment and convulsions. Many non-steroidal anti-inflammatory drugs interact with lithium to increase its plasma... 

Two patients stabilised on lithium carbonate (serum level 0.75 mmol/L) showed signs of lithium toxicity (tremor, faseieulations, museular weakness, dysarthria, apathy) within a few days of being given eo-trimoxazole [dose not stated], yet their serum-lithium levels were found to have fallen to about 0.4 mmol/L. Within 48 hours of withdrawing the eo-trimoxazole, the signs of toxicity had gone, and their serum-lithium eoneentrations had returned to their former levels. Another report very briefly states that ataxia, tremor and diarrhoea developed in a patient on lithium and timolol when co-trimoxazole was given. ... 

A 40-year-old woman taking lithium 1.2 g daily, experienced nausea, diarrhoea, malaise, difficulty concentrating, trembling, an uncertain gait and muscle spasms after trimethoprim 300 mg daily was started her serum-lithium levels appeared to be elevated. She made a good recovery following rehydration. ... 

Lithium carbonate is used in the treatment of manic depressive illnesses. The exact mechanism of its action is not known but it may interfere with cyclic-AMP mediated processes. The level of the drug in the blood must be monitored periodically as toxic reactions (tremors, diarrhoea, vomitting and drowsiness) can result from overdosage. Recently it has been found that lithium inhibits thyroxine biosynthesis and this may lead to hypothyroidism. 

You re on-call one weekend. The nursing staff ask you to review Lucy Taylor, 69. She relapsed with mania 6 weeks ago, after stopping her lithium suddenly. She s been in the wars having suffered a sprained ankle a week ago, she s now gone down with a tummy bug and has diarrhoea. She s weak, wobbly and shaky. 

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