From my experience, the patient was a male African-American who had an history of bipolar, Dyslipidemia, diabetes gout and hypertension who was brought in for treatment. The patient was in critical situation when brought in for stabilization and management of his disorders. According to his family members, the patient had refused to orally take any food for the past 40 hours. Poor judgement and insight were among the signs shown as he isolated himself to his room. The patient was on a daily medication of Metformin 75 Mg, hydrochlorothiazide 25mg, Lithium 300 mg, 10 units of Lantus insulin and 20mg of Crestor.
There are four processes that drugs pass through in the body including absorption where the patient ingests the drug. Distribution is where drug reaches the liver from GI through portal circulation. The third step includes glucuronidation and oxidation of the drug. The final step involves the kidney excreting metabolite drugs through the aid of glomerular filtration rate (GFR). According to basic Pharmacokinetic process, many factors could have affected how the body functions on drugs. Given the age of the patient, glomerular filtration could have affected him considering that functions of most organs slow down at old age (Jacobson, 2013). Moreover, regular metabolism monitoring and Lithium toxicity should be taken under consideration.
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In pharmacodynamic, action is witnessed once drugs reach the target. Effects of the drug can be on the inhibition of enzyme, presynaptic or postsynaptic. As explained by the patient’s family, he did not stop his medication. However, there were no signs of Lithium toxicity including confusion, vomiting, coma and seizures dysarthria. From the lab test, it was revealed that lithium level in the patient’s body was 2.9mmol/L exceeding the required level for his age which is often between 0.4 and 0.8mmol/L.
My personal plan for care would be to immediately stop all his medications containing lithium and educate the family on how to manage lithium intake and to report any signs and symptoms to the care provider. At this point, the plan is to reduced lithium on a weekly basis until serum level stabilizes in the first two weeks of in six months (Arcangelo & Peterson, 2013). We would also need to restore glomerular filtration rate through increasing fluid intake. We would have to normalize output of urine and enhance clearance of lithium. In extreme cases, dialysis would be required to get rid of toxic waste from the body system.
References
Arcangelo, V.P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice:
A practical approach (3 rd ed.). Ambler, PA: Lippincott Williams & Wilkins
Jacobson, S. (2013) Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly
Journal of Psychiatric Times January 2013 Retrieved from Walden library databases
