Mei Kimura is a 29-year-old Japanese person (pronouns they/them/their) who comes to see you in your office after they were hospitalized for 14 days for a manic episode. Mei has bipolar I disorder. They are 5’ 8” and 150 pounds.
Questions
Mei is currently prescribed lithium CR 900 mg daily. Their most recent lithium level was 0.6 m Eq/L.
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What psychiatric disorders and/or symptoms is lithium FDA-indicated to treat?
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What phase of bipolar (such as manic, mixed, depressed) is lithium most effective in managing?
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How does lithium work; what is the mechanism of action?
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What formulations does lithium come in? What dosing differences are there (if any) based on the formulation (such as frequency, starting dose, and so on)?
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What laboratory testing should be ordered
before
starting lithium?
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What is the normal reference range for monitoring lithium levels?
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Based on Mei’s lithium level and how they present to you, what changes (if any) would you make with Mei’s lithium CR? Why? Provide the dose, route, and timing/frequency for all medication changes.
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When would you check another lithium level (that is, how many days after starting or changing the dose, what time of day/how long after the last dose would you check it)?
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Identify the most commonly expected side effects associated with lithium about which you would educate the patient.
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Identify the most serious potential adverse effects associated with lithium about which you would educate the patient to immediately report.
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Identify any drug-drug, food-drug, substance-drug, or herb-drug interactions that Mei should avoid while taking lithium.
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