Advice on Lithium Monitoring for Inpatients
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Is the patient currently taking Lithium?
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NO
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No further action required. Please see local policy for initiating new patients on Lithium.
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YES
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Has medicine reconcilliation process
been completed and identified minimum 2 consistent sources of Lithium dose and timing?
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NO
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Withold Lithium until this is complete
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YES
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Are the details of medicine reconcilliation consistent with wjhat patient reports they are taking?
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NO
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Withold Lithium until dose clarified and level checked
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YES
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As the patient if they are experiencing any of the following?
Nausea Diarrhoea Blurred vision Polyuria Light headedness Fine resting tremor Muscular weakness Drowsiness
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YES
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Withold Lithium until level checked
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Ask patient if they have been taking any of the following?
NSAIDS
ACE inhibitors Diuretics
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YES
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Withold Lithium until level checked
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NO
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Check most recent Lithium level, U&Es and ECG.
Any abnormalities?
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YES
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Withold Lithium until level checked and discuss with treating team
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NO
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Check Lithium level at 10am the morning following admission
RESULTS:
Level<0.4- D/W treating team
Level 0.4-1- continue
>1-1.5- withhold and D/W pharmacy and treating team
>1.5 withold and monitor for signs of toxicity. D/W pharmacy and treating team
>2 Immediate physical monitoring inc renal function and ECG. D/W Medics
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Inpatient Lithium Flowchart
