Paper I
2024 December (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

The following statements concerning the use of lithium in the management of bipolar affective disorder is TRUE:

  1. Excessive intake of sodium chloride enhances the toxicity of lithium
  2. Lithium alleviates the manic phase of bipolar disorder in 24 hours
  3. Lithium dosage may need to be reduced in patients taking diuretics
  4. Lithium has narrow margin of safety and requires therapeutic drug monitoring
  • a) 1 & 3
  • b) 2 & 3
  • c) 3 & 4
  • d) 2 & 4 (PTO)
Qix1 marksMCQs

Answer

Correct answer: c) 3 & 4

Lithium has a narrow margin of safety and requires therapeutic drug monitoring, and its dose may need reduction with diuretics (particularly thiazides, which reduce renal lithium clearance and raise plasma levels, risking toxicity). Excessive sodium intake actually reduces lithium levels (lithium and sodium compete for renal tubular reabsorption, so high sodium promotes lithium excretion) — sodium restriction raises toxicity risk, not excess intake. Lithium’s antimanic effect has a slow onset (1-2 weeks), not 24 hours.

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