Lithium Lab Values

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Abby Rose
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Outline

Objective:

Determine the significance and clinical use of the lab value of Lithium in clinical practice

 

Lab Test Name:

Lithium

 

Description:

Labs to determine levels in the blood are taken periodically to monitor for therapeutic dosing and to avoid toxicity 

Measures Lithium concentration in a blood sample

  • Monitor concentration in the blood
    • Every 6-12 months once dosage stabilizes
  • Evaluates both intake and excretion

 

Indications:

This lab test is conducted to monitor therapeutic levels and determine if adjustments need to be made

  • S/S toxicity
  • Hypothyroidism
  • Monitoring levels once dosage is stable
  • Dose adjustment

Normal Therapeutic Values:

Normal:

0.6-1.2 mEq/L

Collection:

  • Clot activator tube- plain red

 

What would cause increased levels?

INCREASED: 

  • Excessive intake
    • Dosage adjustment
    • Intended or accidental over ingestion
  • Impaired excretion
    • Renal insufficiency – 
    • Dehydration- 
  • Reduced sodium and/or caffeine intake

 

What would cause decreased levels?

DECREASED:

Inadequate intake of medication

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Transcript

Hi there, my name’s Abby and I’m here with nursing.com to discuss a lab value with you for lithium. We’ll talk about its normal value when it’s used and indications in clinical practice. We’ll also talk about what it means when values are increased or decreased. Let’s get started.

 

Lithium lab measures the lithium concentration in a blood sample. Lithium is a mood stabilizing medication. That’s used to treat manic depression or bipolar. Now, it’s monitored every 6 to 12 months once the dosage is stabilized. That’s really important because toxicity can honestly, it can be fatal. So, we need to know exactly where those levels are when any dose change takes place. It’s going to evaluate for both how much is being taken in, and how much is being excreted. Very important. Some clinical indications for having this lab drawn are, if someone presents with signs and symptoms of toxicity briefly. These would include nausea and vomiting. It could be that the patient is lethargic. They might even be tachycardic and truly, it can get as serious as coma and seizures. Lithium is known to inhibit thyroid function and so patients with hypothyroidism that are taking lithium also need to be evaluated regularly.

 

I mentioned that once the dose is stable, that’s when regular monitoring intervals can be established, but it should also be taken anytime there’s a dose adjustment. Normal therapeutic values are between 0.6 and 1.2 mmol/L. Toxic levels are going to be greater than 1.6 mmol/L.  Collection of the specimen takes place in a clot activator tube like this red one here. Increased lab values are related to excessive intake or impaired excretion. Excessive intake can be relevant to a dose adjustment, or it could even be intended or accidental over ingestion. Impaired excretion of course is going to talk about the kidney. The kidney is responsible for metabolizing and excreting lithium therefore, if it’s insufficient in function, we’re going to have a rise in lithium values. Dehydration also plays a role because we think about the ratio of hydration or, uh, liquid fluid levels in the body versus salutes like a medication like lithium. It’s also been attributed to be on the rise or an elevated value of lithium when there’s reduced sodium or caffeine intake in the diet. And then, the inverse is true. If there’s an increase in sodium intake or caffeine, it can actually decrease levels of lithium. Decreased levels will also be attributed to an inadequate intake of medication or a dose adjustment. 

 

Now, linchpins for this lesson are that the lithium lab is drawn to evaluate the concentration of lithium in the blood. It’s a mood stabilizing medication. Normal values are between 0.6 and 1.2 mmol/L. Remember if it’s greater than 1.6 mmol/L, that is considered a toxic level. If the value is increased, we can attribute that to either excessive intake of the medication or impaired excretion of the medication as would be, uh, seen in kidney disease. A decreased value is either going to be attributed to an inadequate intake or a dose adjustment. 

 

All right, you all did great with this lesson, this wraps it up on lithium. Remember, we know you can do it, and we love you! Now go out, be your best self today and as always, happy nursing!

References:

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Med-Surge 3

Concepts Covered:

  • Gastrointestinal
  • Liver & Gallbladder Disorders
  • Disorders of Pancreas
  • Oncology Disorders
  • Central Nervous System Disorders – Brain
  • Upper GI Disorders
  • Medication Administration
  • Lower GI Disorders
  • Disorders of the Adrenal Gland
  • Disorders of the Thyroid & Parathyroid Glands
  • Hematologic Disorders
  • Studying
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Cognitive Disorders
  • Eating Disorders
  • Depressive Disorders
  • Personality Disorders
  • Psychotic Disorders
  • Trauma-Stress Disorders
  • Bipolar Disorders
  • Developmental Considerations
  • Concepts of Mental Health
  • Health & Stress
  • Psychological Emergencies
  • Somatoform Disorders
  • Communication
  • Test Taking Strategies
  • Adult
  • Emergency Care of the Cardiac Patient
  • Intraoperative Nursing
  • Microbiology
  • Cardiac Disorders
  • Vascular Disorders
  • Nervous System
  • Gastrointestinal Disorders
  • Immunological Disorders
  • Fundamentals of Emergency Nursing
  • Dosage Calculations
  • Understanding Society
  • Circulatory System
  • Concepts of Pharmacology
  • Newborn Care
  • Adulthood Growth and Development
  • Respiratory Disorders
  • Postoperative Nursing
  • Pregnancy Risks
  • Neurological
  • Postpartum Complications
  • Noninfectious Respiratory Disorder
  • Peripheral Nervous System Disorders
  • Learning Pharmacology
  • Prenatal Concepts
  • Tissues and Glands
  • Disorders of the Posterior Pituitary Gland
  • Endocrine
  • Renal Disorders
  • Disorders of Thermoregulation
  • Female Reproductive Disorders
  • Sexually Transmitted Infections
  • Acute & Chronic Renal Disorders
  • Shock

Study Plan Lessons

05.02 Liver Overview and Disease for CCRN Review
Airway Suctioning
Antidiabetic Agents
Cirrhosis Case Study (45 min)
Colonoscopy
Encephalopathies
Enteral & Parenteral Nutrition (Diet, TPN)
Gastrointestinal (GI) Bleed Concept Map
Insulin
Insulin Mnemonic (Ready, Set, Inject, Love)
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Pancreatitis
Nursing Case Study for Hepatitis
08.01 Psychological Review for CCRN Review
Addiction – Behavioral Problems Nursing Mnemonic (The 5 D’s)
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alcohol Withdrawal Case Study (45 min)
Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alprazolam (Xanax) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Ammonia (NH3) Lab Values
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Antianxiety Meds
Antianxiety Meds
Antidepressants
Antidepressants
Antipsychotics
Antipsychotics
Anxiety
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Atypical Antipsychotics
Benzodiazepines
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Blood Urea Nitrogen (BUN) Lab Values
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Buspirone (Buspar) Nursing Considerations
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Carbamazepine (Tegretol) Nursing Considerations
Chloride-Cl (Hyperchloremia, Hypochloremia)
Chlorpromazine (Thorazine) Nursing Considerations
Cholesterol (Chol) Lab Values
Cognitive Impairment Disorders
Creatinine (Cr) Lab Values
Day in the Life of a Hospice, Palliative Care Nurse
Day in the Life of a Mental Health Nurse
Defense Mechanisms
Defense Mechanisms
Dementia Nursing Mnemonic (DEMENTIA)
Depression
Depression Assessment Nursing Mnemonic (SIGNS)
Depression Concept Map
Diazepam (Valium) Nursing Considerations
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Dissociative Disorders
Divalproex (Depakote) Nursing Considerations
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Encephalopathy Case Study (45 min)
End of Life for Progressive Care Certified Nurse (PCCN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Generalized Anxiety Disorder
Glomerular Filtration Rate (GFR)
Grief and Loss
Grief and Loss
Haloperidol (Haldol) Nursing Considerations
Handling Death and Dying
Head to Toe Nursing Assessment (Physical Exam)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Hypochondriasis (Hypochondriac)
Lamotrigine (Lamictal) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lithium Lab Values
Liver Function Tests
Lorazepam (Ativan) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
MAOIs
Meds for Alzheimers
Mental Health Course Introduction
Metabolic Alkalosis
Methadone (Methadose) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar)
Mood Stabilizers
Mood Stabilizers
Nurse-Patient Relationship
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Depression
Nursing Care Plan (NCP) for Dissociative Disorders
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Bipolar Disorder
Nursing Case Study for Mania (Manic Syndrome)
Olanzapine (Zyprexa) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Palliative Care for Progressive Care Certified Nurse (PCCN)
Paranoid Disorders
Paroxetine (Paxil) Nursing Considerations
Personality Disorders
Phases of Nurse-Client Relationship
Phosphorus-Phos
Post-Traumatic Stress Disorder (PTSD)
Postmortem Care
Potassium-K (Hyperkalemia, Hypokalemia)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Quetiapine (Seroquel) Nursing Considerations
Schizophrenia
Schizophrenia Case Study (45 min)
Self Concept
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Sertraline (Zoloft) Nursing Considerations
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Somatoform Disorder Case Study (30 min)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
SSRIs
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Suicidal Behavior
TCAs
Therapeutic Communication
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Total Bilirubin (T. Billi) Lab Values
Types of Schizophrenia
Urinalysis (UA)
Vitamin B12 Lab Values
12 Points to Answering Pharmacology Questions
6 Rights of Medication Administration
ACLS (Advanced cardiac life support) Drugs
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Anesthetic Agents
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Antidepressants
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Barbiturates
Bariatric: IV Insertion
Basics of Calculations
Benztropine (Cogentin) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
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Cefdinir (Omnicef) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Combative: IV Insertion
Complex Calculations (Dosage Calculations/Med Math)
Cyclosporine (Sandimmune) Nursing Considerations
Dark Skin: IV Insertion
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Drawing Blood from the IV
Drawing Up Meds
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Epoetin Alfa
Eye Prophylaxis for Newborn
Fentanyl (Duragesic) Nursing Considerations
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Glipizide (Glucotrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hanging an IV Piggyback
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Hydralazine
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin Drips
Insulin Mixing
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
IV Catheter Selection (gauge, color)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
IV Infusions (Solutions)
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
IV Pump Management
IV Push Medications
Ketorolac (Toradol) Nursing Considerations
Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)
Lidocaine (Xylocaine) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
MAOIs
Medication Errors
Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)
Medications in Ampules
Meds for Postpartum Hemorrhage (PPH)
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Methylergonovine (Methergine) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Nalbuphine (Nubain) Nursing Considerations
Needle Safety
Neostigmine (Prostigmin) Nursing Considerations
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nitro Compounds
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
Nystatin (Mycostatin) Nursing Considerations
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Olanzapine (Zyprexa) Nursing Considerations
Opioid Analgesics in Pregnancy
Oral Medications
Oxycodone (OxyContin) Nursing Considerations
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Parasympathomimetics (Cholinergics) Nursing Considerations
Patient Controlled Analgesia (PCA)
Pediatric Dosage Calculations
Pentobarbital (Nembutal) Nursing Considerations
Pharmacodynamics
Pharmacokinetics
Pharmacokinetics Nursing Mnemonic (ADME)
Pharmacology Course Introduction
Phenobarbital (Luminal) Nursing Considerations
Phytonadione (Vitamin K) for Newborn
Pill Crushing & Cutting
Positioning
Procainamide (Pronestyl) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rh Immune Globulin in Pregnancy
Sedatives-Hypnotics
Sedatives-Hypnotics
Selecting THE vein
Spiking & Priming IV Bags
Starting an IV
Streptokinase (Streptase) Nursing Considerations
Struggling with Dimensional Analysis? – Live Tutoring Archive
SubQ Injections
Supplies Needed
Tattoos IV Insertion
TCAs
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Verapamil (Calan) Nursing Considerations
03.02 Diabetes Insipidus for CCRN Review
03.01 Syndrome of Inappropriate Antidiuretic hormone (SIADH) for CCRN Review
03.03 Hypoglycemia for CCRN Review
03.04 DKA vs HHNK for CCRN Review
05.02 Liver Overview and Disease for CCRN Review
Absolute Neutrophil Count (ANC) Lab Values
ACE (angiotensin-converting enzyme) Inhibitors
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Airway Suctioning
Anion Gap
Calcium Channel Blockers
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Coagulation Studies (PT, PTT, INR)
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Cushings Assessment Nursing Mnemonic (STRESSED)
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Management
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
DKA Treatment Nursing Mnemonic (KING UFC)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypertonic Solutions (IV solutions)
Hypoparathyroidism
Hypothermia (Thermoregulation)
Hypotonic Solutions (IV solutions)
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Iron (Fe) Lab Values
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Leukemia Case Study (60 min)
Lymphoma
Metformin (Glucophage) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Multiple Myeloma
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan for Cirrhosis (Liver)
Nursing Case Study for Type 1 Diabetes