Clinical Case Scenario
A 40-year-old man with a history of congestive heart failure (CHF) and bipolar affective disorder, currently on treatment with oral lithium (figure 1), presents to the emergency department. He exhibits ataxia, tremors, and confusion. His family reports a 4-day history of a viral illness with poor oral intake for the past 3 days.
Figure 1: Oral lithium tablets (source: Google image)
His current lab results are as follows:
Na: 140 mEq/L, K: 3.5 mEq/L, Cl: 100 mEq/L
HCO3: 28 mEq/L, BUN: 30 mg/dL, Creatinine: 1.5 mg/dL
Lithium level: 3.0 mEq/L (normal range: 0.6–1.0 mEq/L)
What is the most appropriate immediate next step in his management?
