22nd February 2024

A 32 year old female presents to A&E with increasing drowsiness, lack of coordination and vomiting.

A 32 year old female presents to A&E with increasing drowsiness, lack of coordination and vomiting. She has a history of Bipolar Disorder for which she takes Lithium and hypothyroidism for which she takes levothyroxine. She has also recently started taking regular ibuprofen in addition to paracetamol to help control her chronic back pain. Her blood test results are as follows:

Na 136 (135-145 mmol/l)
K+ 5 (3.5-5 mmol/l)
Ur 9 (3-7 mmol/l)
Cr 158 (60-125 umol/l)
Hb 120 (120-150 g/L female)
WCC 6 (4-11 x 10^9/l)
TSH 3 (0.5-5 ulU/l)
Lithium 2.1

You are asked to prescribe this patient’s regular medication whilst treatment is arranged; select the most appropriate option for initially managing this patient: