14th February 2025

A 56-year-old lady has been taking lithium for her bipolar affective disorder for 12 years.

A 56-year-old lady has been taking lithium for her bipolar affective disorder for 12 years. She has previously tolerated it well but has started to develop weight gain, fatigue and constipation and would like to switch to a different drug.

Her community mental health team organise the following blood tests:

Haemoglobin 134 g/L (130-180)

White Cell Count 4.2 x10⁹/L (3.6-11)

Neutrophils 2.2 x10⁹/L (1.8-7.5)

Platelet Count 141 x10⁹/L (140-400)

Sodium 142 mmol/L (135-145)

Potassium 5.2 mmol/L (3.5-5.3)

Urea 7.1 mmol/L (2.5-7.8)

Creatinine 101 micromol/L (59-104)

eGFR 82

TSH 10.3 mU/L² (0.4-4)

Free T4 2.1 pmol/L (9-24)

Calcium (adjusted) 2.41 mmol/L (2.2-2.6)

Phosphate 1.11 mmol/L (0.74-1.4)

Albumin 47 g/L (35-50)

ALP 108 U/L (30-130)

Which of the following is not an adverse effect of lithium?

Select the SINGLE most appropriate option from the list below. Select ONE option only.