Therapeutic: 0.6-1.2 mEq/L\nAcute mania: 0.8-1.2 mEq/L\nTOXIC: >1.5 mEq/L\nDraw level: 12 hours after last dose\nNarrow therapeutic index — monitor closely!

Early (1.5-2.0): Fine tremor, nausea, vomiting, diarrhea\nModerate (2.0-2.5): Coarse tremor, confusion, ataxia, slurred speech\nSevere (>2.5): Seizures, coma, cardiac arrhythmias, death\nANTIDOTE: No specific antidote — supportive care, IV fluids, hemodialysis

INCREASES lithium levels:\n• Low sodium diet\n• Dehydration\n• NSAIDs (ibuprofen, naproxen)\n• Thiazide diuretics\n• ACE inhibitors\nTEACH: Use acetaminophen for pain, maintain fluid/sodium intake

NMS (antipsychotics):\n• Hyperthermia, severe rigidity\n• Altered consciousness, autonomic instability\n• Slow onset (days-weeks)\nSerotonin Syndrome (SSRIs/serotonergic drugs):\n• Hyperthermia, agitation, CLONUS\n• Diarrhea, hyperreflexia\n• Rapid onset (hours)

TARDIVE DYSKINESIA — involuntary repetitive movements (lip smacking, tongue thrusting, grimacing)\n• Potentially irreversible\n• Use AIMS scale to assess\n• Risk increases with dose and duration\n• Switch to atypical antipsychotic if possible

SUICIDALITY — Increased risk of suicidal thinking in children, adolescents, and young adults (18-24)\n• Monitor closely first 4 weeks\n• Full effect takes 4-6 weeks\n• Do NOT stop abruptly (discontinuation syndrome)\n• Do NOT combine with MAOIs (fatal serotonin syndrome)

Benzodiazepines → Flumazenil (Romazicon)\nOpioids → Naloxone (Narcan)\nAcetaminophen → N-acetylcysteine (NAC)\nNo specific antidote for: lithium, antipsychotics, SSRIs\n(supportive care used instead)

Monitor: Weight, BMI, fasting glucose, HbA1c, fasting lipids, BP\nFrequency: Baseline, 3 months, then annually\nRisk: Metabolic syndrome, diabetes, dyslipidemia\nBlack box: Elderly with dementia — increased mortality risk