Question 1 of 10
Person-Centered Assessment and Treatment Planning
Patient Profile
Patient profile| Item | Detail |
|---|
| Age / sex | 36-year-old woman |
| Height / weight | 165 cm; 62 kg |
| Allergies | No known drug allergies |
| Diagnoses | Bipolar I disorder (stable for 4 years); hypertension (diagnosed 1 month ago); hypothyroidism |
| Presentation | 3 days of diarrhea, coarse hand tremor, and an unsteady gait; alert and oriented; no seizures |
Current medications| Medication | Directions | Notes |
|---|
| Lithium carbonate ER 450 mg | 1 tablet PO twice daily | Same dose for 4 years; last dose 8 PM yesterday |
| Hydrochlorothiazide 25 mg | 1 tablet PO daily | Started 3 weeks ago |
| Levothyroxine 50 mcg | 1 tablet PO daily | Since 2023 |
| Acetaminophen 500 mg | 1–2 tablets PO every 6 hours as needed | Rarely used |
Laboratory results (today, 8 AM)| Test | Result | Reference range |
|---|
| Lithium (12 hours post-dose) | 2.3 mEq/L | 0.6–1.2 mEq/L |
| Sodium | 132 mEq/L | 135–145 mEq/L |
| Serum creatinine | 1.3 mg/dL (baseline 0.8) | 0.6–1.1 mg/dL |
| TSH | 2.0 mIU/L | 0.4–4.0 mIU/L |
| Calcium | 9.6 mg/dL | 8.5–10.2 mg/dL |
Vital signs| Parameter | Value |
|---|
| Blood pressure | 108/68 mm Hg |
| Heart rate | 96 beats/min |
| Temperature | 37.0 °C |
Which is the most appropriate initial management of her lithium toxicity?