A patient shows which of the following symptom of overdose of lithium?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2021

Explanation

Lithium overdose impairs the kidneys' ability to concentrate urine by antagonizing the effects of antidiuretic hormone (ADH).
This condition is known as nephrogenic diabetes insipidus.
It leads to the excretion of large volumes of dilute urine (polyuria).
To compensate for the significant fluid loss, the body's thirst mechanism is activated, causing the patient to drink excessive amounts of water (polydipsia).

Why Other Options Were Wrong

Option B: Lithium is commonly associated with weight gain as a side effect, not weight loss.
Option C: Lithium stimulates the bone marrow, often leading to an elevated white blood cell count (leukocytosis).
Option D: Early to moderate lithium toxicity typically presents with neuromuscular hyperexcitability, including coarse tremors and hyperreflexia (exaggerated reflexes).

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs and symptoms of lithium toxicity to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients on long-term lithium therapy to recognize and report early signs of toxicity, such as increased thirst, frequent urination, and worsening tremors.
It is crucial to teach patients to maintain adequate hydration (2-3 L/day) and a stable salt intake, as dehydration or low sodium levels can dangerously increase serum lithium concentrations.
What if? If the patient was also taking an NSAID (like ibuprofen) or a thiazide diuretic, the risk of lithium toxicity would be significantly higher because these drugs reduce renal clearance of lithium, requiring closer monitoring and possible dose adjustments.

How to Approach the Question

First, identify the key subject of the question, which is 'lithium overdose'.
The question asks to identify a specific symptom from the given options.
Recall the major side effects and toxicity profile of lithium, focusing on its effects on different body systems (renal, neurological, endocrine, etc.).
Evaluate each option: Polyuria (excessive urination) and polydipsia (excessive thirst) are classic signs of lithium-induced nephrogenic diabetes insipidus, a key feature of toxicity.
Eliminate the other options based on your knowledge: Lithium causes weight gain (not loss), leukocytosis (not leukocytopenia), and hyperreflexia (not hyporeflexia) in early to moderate toxicity.
Select the option that aligns with the most common and characteristic signs of lithium overdose.

Concept Tested & Keywords

Concept Tested: Signs and symptoms of lithium toxicity
Stem keywords: lithium, overdose, symptom
Lead-in keywords: which of the following

Question ID

QpqceJS4-_RbQe7Tl_SdMO

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 2054-2056, 2055-2057

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 10770-10772

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