Therapeutic level of lithium is:
Ans: c (10/15 ) Ref:Katzung, 10th ed, p. 455Surprised!!!? There is common consenses that option c was definitely 10/15andnot 10-15.Even though there is a chance that it was a typing error, going by basic mathematics the option (c) 10/15 = 0.666.This definitely falls between the range 0.6-1.25 which is considered as the effective and safe concentration of lithium. The next best option might be a) 1 -5 mEq/L.LITHIUMLithium carbonate is often referred to as an "antimaniac" drug and is considered as a "mood-stabilizing" agent because of its primary action of preventing mood swings in patients with bipolar affective (manic- depressive) disorder.Concentrations considered to be effective and acceptably safe are between 0.6 and 1.25 mEq/L.The range of 0.9-1.1 mEq/L is favoured for treatment of acutelymanic or hypo manic patients.Somewhat lower values (0.6-0.75 mEq/L) are considered adequate and are safer for long-term use for prevention of recurrent manic-depressive illness.Adverse Effects & Complications of Lithium.1) Neurological and psychiatric manifestationsTremor is one of the most common adverse effects of lithium treatment.Treatment - propranolol.Appearance of any new neurologic or psychiatric symptoms or signs is a clear indication for temporarily stopping treatment with lithium and close monitoring of serum levels.2) Decreased thyroid functions - reversibleThyroid function test (TFT) should be done before starting the drug.3) Nephrogenic diabetes insipidus and other renal adverse effectsDue to loss of responsiveness to ant diuretic hormone (nephrogenic diabetes insipidus). Lithium-induced diabetes insipidus is resistant to vasopressin but responds to amiloride.4) OedemaOedema is a common adverse effect of lithium treatment and may be related to some effect of lithium on sodium retention.5) Cardiac adverse effectsThe bradycardia-tachycardia ("sick sinus") syndrome is a definite contraindication to the use of lithium because the ion further depresses the sinus node.6) Use m pregnancyLithium is contraindicated during pregnancy. It causes fetal goiter,Ebteins anomaly etc. More recent data suggest that lithium carries a relatively low risk of teratogenic effects.7. Miscellaneous adverse effectsTransient acneiform eruptionsFolliculitisBRIDGE Leukocytosis is always present during lithium treatment (direct effect on leucopoiesis) - used therapeutically in patients with low leukocyte counts.
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