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cce_psychiatry_bipolar_lithium (pregnancy) (toxicity (STOP (lithium, NSAID…
cce_psychiatry_bipolar_lithium (pregnancy)
toxicity
chronic renal disease
(NSAID, thiazide, ACEI: reduce renal clearance) drugs
dehydration
oral
side effects
concentration, memory
polyuria polydipsia, weight gain
toxicity
STOP
lithium
NSAID, thiazide, ACEI
ICU
resuscitation
vitals
further assessment
input/output, electrolyte, RFT
renal failure
hemodialysis
convulsion
anticonvulsant
toxicity
1.5 - 2 mmol/L
coarse tremor, muscle weakness
nausea vomiting, diarrhea
more than 2 mmol/L
convulsion, nystagmus
hypotension, coma
antepartum
STOP 3 months before pregnancy - first trimester
postpartum
frequent follow-up (depression, psychosis)
restart immediately after deliery
so x breastfeeding
intrapartum
early morphology 16-18 weeks
family support (red flag signs)
frequent follow-up (restart antidepressant/admit if needed)
stable
v stable
first trimester: teratogenicity, second trimester: prematurity
risk of relapse (antepartum, postpartum depression)
lower dose, taper off, change drug,
psychological treatment
,
social treatment
x stable
NOPE