Fetal exposure during the first trimester creates a risk of Ebstein’s anomaly with right ventricular hypoplasia and downward displacement of the triscuspid valve of approximately .05-0.1%.

Relative risk of Ebstein’s anomaly in infants exposed to this drug is 10-20 times that of the general population.

Used to treat bipolar disease.

Lithium drugs have a narrow therapeutic index, and therapeutic drug monitoring is used to maintain serum concentration within the therapeutic range of 0.6-1.5 mEq/L.

Decreases suicide risk in patients treated for mood disorders.

Randomized control studies that lithium compared to placebo reduces number of suicides by 13% and deaths from any cause by 38%

Lithium reduces suicide risk and total mortality in patients with depressive episodes or bipolar disorders.

Does not reduce risk of non-fatal self harm.

Adverse effects include: renal dysfunction, hypothyroidism, hyperparathyroidism, and weight gain.

Lithium nephropathy divided into three categories: one acute intoxication, two nephrogenic diabetes insipidus and three chronic renal disease.

To reduce the risk of toxicity patients should consume 8-12 glasses of water daily, avoid the use of nonsteroidal anti-inflammatory drugs and other medications that may increase lithium blood concentrations and temporary halt lithium treatment during diarrheal illnesses, if vomiting, or if exposed to other causes of severe dehydration.

Nephrogenic diabetes insipidus occurs in up to 40% of patients on lithium.

About 80% of lithium ingested appears to affect the proximal tubules by entering the collecting tubule cells through sodium channels, accumulating and interfering with the normal response to antidiuretic hormone.

Nephrogenic diabetes insipidus is reversible if treatment with the drug is stoped soon after initiation, but is frequently not reversible in patients treated for years.

Increased duration of lithium treatment increases progression to end stage renal disease as does the a cumulative dose.

When lithium nephropathy develops the drug should be discontinued and if it cannot be discontinued concomitant use of amiloride can improve or lesson the severity of nephrogenic diabetes

Increased duration of usage increases the likelihood of focal interstitial nephritis, tubular atrophy, glomerulosclerosis, and distal tubular dilation with microcysts.

Renal cysts occur it up to 62% of patients on lithium.

Factors associated of progression of kidney disease include duration of usage, increased age, hypertension, diabetes, hyperparathyroidism, and hyperuricemia.

Up to 20% of patients on lithium have progressive decrease in GFR.

Cessation of lithium therapy does not necessarily stop the progression of lithium-associated renal disease.

Lithium levels above 1.5 mEq per liter can contribute to lithium toxicity.

Lithium toxicity can include: nausea, abdominal pain, vomiting, diarrhea, fatigue, drowsiness, lethargy, confusion, and tremor.

If left untreated, lithium toxicity can progress coma, seizures, ataxia, and renal insufficiency.

Approximately one in 100 patients per year receiving lithium experience moderate to severe lithium intoxication.

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