Mood Stabilizers

Lithium
1. Monitor therapeutic level
  1. 0.6-1.2 mEq/L
  2. Frequency per protocol
    1. More often after initiation
    2. Then monthly
  3. Best drawn in morning, approximately 12 hours since last dose
2. Caution in Pregnancy
3. Things that can cause toxicity:
  1. Dehydration
  2. ETOH
  3. Caffeine
  4. Diuretics
4. Promote appropriate fluid balance

Toxicity

Lithium toxicity
1. Can be mild, moderate, or severe
2. Kidneys cannot excrete it; builds up
3. Usually when serum levels are 1.5 – 2 mEq/L
4. Know symptoms
  1. N/V/D
  2. Weakness
  3. Tremor
  4. Seizures
  5. Hallucinations
5. Interventions
  1. Assess patient
    1. Full set of VS
    2. EKG
    3. LOC
  2. Hold dose, notify Provider
  3. Obtain labs: CBC, lithium level, CMP/BMP
  4. Initiate suicide precautions

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Transcript

Okay this lesson is going to talk about Mood Stabilizers.

Mood stabilizers work to regulate and stabilize mood by enhancing either serotonin or GABA. Remember serotonin is the happy hormone. GABA is the calming hormone. Now the most common mood stabilizer you’ll see is Lithium, and it’s also the one with the most significant nursing considerations! Lithium works by increasing serotonin levels and it also decreases norepinephrine. So if you remember when we talked about antidepressants, there were some that actually increased both of these… but Lithium is all about balance, right – we don’t want to JUST bring them up, we also want to keep them from going up too high! Big note about Lithium is that it has a very narrow therapeutic window – now this may swing by 0.1 one way or the other depending on the source you are using, but it is approximately 0.8 to 1.2 mg/dL. Most patients will start showing signs of toxicity around 1.5 to 2 mg/dL. Most patients will have their therapeutic levels checked pretty regularly when the first start, so check your orders. Long-term we usually check levels about once a month.

Dehydration is one thing that puts patients at much higher risk for lithium toxicity. We want to encourage these patients to drink 2-3 liters a day of water. Other things that can put them at risk are over the counter meds, caffeine, alcohol, and diuretics – really anything with a diuretic effect or that can cause dehydration. That therapeutic window is so small that the concentration of lithium will go up if they get dehydrated at all.

Make sure you know signs of lithium toxicity – they’ll have nausea, vomiting, and diarrhea, drowsiness, tremor, lack of coordination, blurry vision, and ringing in their ears. Think about it this way – lithium is trying to balance the seesaw, but if I have too much, the seesaw just swings back and forth. So lack of coordination, drowsy, etc. So if you suspect lithium toxicity – do NOT give another dose, assess your patient to make sure they’re stable – get a set of vitals and an EKG and assess their level of consciousness. Then notify the provider – they’ll probably order some labs, including a lithium level. And we want to consider putting this patient on suicide precautions because they’re about to be off their meds for a bit until we figure this out.

Okay let’s recap – mood stabilizers work by enhancing either serotonin (the happy hormone) or GABA (the calming hormone). Lithium specifically enhances serotonin and decreases norepinephrine and has a very narrow therapeutic window. Dehydration and some other substances can increase the risk for toxicity. The symptoms of toxicity are tremor, nausea, vomiting, and drowsiness. If you suspect it, hold the drug, assess the patient, and notify the provider.

That’s it for mood stabilizers. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!