If a patient on lithium has a level of 1.3 mEq/L, what is the appropriate action?

• A. Do not give the next dose and assess for symptoms
• B. Proceed with the next planned dose
• C. Increase the dose by 25%
• D. Discontinue lithium permanently

Answer: (A)

Lithium has a narrow therapeutic window, so any level above the target range requires stopping the next dose and evaluating for toxicity. A typical maintenance range is about 0.6–1.2 mEq/L, with up to 1.5 mEq/L sometimes tolerated during acute treatment; 1.3 mEq/L is mildly elevated and could progress if dosing isn’t adjusted. The safest step is to withhold the next dose and assess for early signs of toxicity (tremor, GI upset, dizziness, confusion, ataxia), then recheck the level in 12–24 hours and review factors that can raise lithium (dehydration, NSAIDs, ACE inhibitors, diuretics). If symptoms develop or the level remains elevated, guidelines call for further dose adjustment and possible medical evaluation; if the level falls back into the therapeutic range without symptoms, resuming lithium with closer monitoring is appropriate.