Manic Mia — Bipolar Mania & Lithium Toxicity
Pressured speech, no sleep for days — then lithium 1.8, coarse tremor, vomiting
Mia has not slept in four days, has booked three flights she cannot afford, and talks so fast the nurse can barely chart it. A week into lithium therapy, she starts vomiting and her hands shake too much to hold a fork.
Mia is in an acute manic episode: euphoric, grandiose, sleepless and spending money she does not have. Mania is managed with a low-stimulation environment, finger foods she can eat on the move, and mood stabilizers like lithium. Lithium has a narrow therapeutic range of 0.6–1.2 mEq/L, and toxicity looks like worsening GI symptoms, coarse tremor, ataxia and confusion — sodium and fluid balance change the level fast.
Read Manic Mia's full story →The story arc
The setup
Mia arrives loud, grandiose and dressed in six clashing colors, certain she is about to close a business deal.
The turn
She paces the unit nonstop, interrupts other patients' therapy groups, and has not eaten a full meal in two days.
The crisis
One week into lithium, Mia has persistent vomiting and diarrhea, a coarse hand tremor, and slurred speech. Her level comes back at 1.8 mEq/L.
The save
The nurse holds the lithium dose, notifies the provider, encourages normal sodium and fluid intake, and monitors for progression to ataxia or seizures.
NCLEX study section — Bipolar Mania & Lithium Toxicity
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.