A nurse is caring for a client who is taking lithium and reports starting a new exercise program. The nurse should assess the client for which of the following electrolyte imbalances?
A.
Hypomagnesemia
B.
Hypokalemia
C.
Hyponatremia
D.
Нуросаlcemia
The Correct Answer and Explanation is:
Correct Answer: C. Hyponatremia
Explanation:
Lithium is a mood stabilizer commonly used to treat bipolar disorder. It has a narrow therapeutic index, meaning that the difference between a therapeutic dose and a toxic dose is small. As such, clients on lithium therapy require careful monitoring of their blood levels, kidney function, and electrolytes.
One of the significant risks associated with lithium therapy is its potential to cause or be influenced by electrolyte imbalances, particularly sodium. Lithium and sodium share similar pathways for reabsorption in the kidneys. When sodium levels in the body drop, the kidneys may reabsorb more lithium, leading to increased lithium levels in the blood. This can result in lithium toxicity, which is a medical emergency.
Hyponatremia (low sodium levels) can be triggered by various factors, including excessive sweating, which is a common outcome of a new exercise program. As the client exercises and sweats more, they lose sodium through their sweat. If the sodium loss is not adequately replaced, the client can develop hyponatremia. The decrease in sodium levels can then increase the risk of lithium toxicity, as the kidneys may retain more lithium to compensate for the lower sodium levels.
Symptoms of hyponatremia can include headache, confusion, seizures, and in severe cases, coma. Lithium toxicity symptoms may include tremors, increased reflexes, confusion, and altered mental status. In a client on lithium, such symptoms can be particularly dangerous and require immediate medical intervention.
While other electrolyte imbalances like hypomagnesemia, hypokalemia, and hypocalcemia can also have significant effects on the body, they are not as directly related to lithium metabolism as sodium. Hypomagnesemia and hypocalcemia could potentially occur but are less common and not as closely tied to lithium’s mechanism of action. Hypokalemia primarily affects cardiac function and muscle activity but is not directly influenced by lithium in the same way sodium is.
Therefore, in a client on lithium therapy who has started a new exercise regimen, it is crucial to monitor for signs of hyponatremia to prevent complications related to lithium toxicity. The nurse should educate the client about the importance of maintaining proper hydration and electrolyte balance, especially during periods of increased physical activity.