A client prescribed lithium carbonate asks why they need blood tests. The nurse explains that lithium has a narrow therapeutic range. What are the signs of lithium toxicity?

LITHIUM TOXICITY — HIGH-YIELD NCLEX CONTENT: THERAPEUTIC RANGE: 0.6-1.2 mEq/L (some sources 0.8-1.2 for bipolar treatment); TOXIC LEVELS: >1.5 mEq/L early toxicity; >2.0 mEq/L serious toxicity; EARLY TOXICITY SIGNS: Coarse tremors; nausea/vomiting; diarrhoea; polyuria; ataxia (coordination problems); slurred speech; SEVERE TOXICITY: Seizures; confusion; cardiac arrhythmias; coma; death; RISK FACTORS FOR TOXICITY: Dehydration (lithium follows sodium — loss of sodium/water concentrates lithium); sodium-restricted diet; NSAIDs (reduce renal excretion); thiazide diuretics; ACE inhibitors; NSAID use; MONITORING: Serum lithium level 12 hours post-dose; BMP (renal function — lithium cleared by kidneys); thyroid function (lithium causes hypothyroidism in 30-40% long-term); PATIENT TEACHING: Maintain adequate sodium and fluid intake; avoid dehydration (illness, excessive sweating); do not change sodium intake dramatically; keep lab appointments; TREATMENT OF TOXICITY: Hold lithium; IV fluids; haemodialysis for severe toxicity.