— 藥理與非經腸給藥 · MEDIUM · MCQ —
病人因躁鬱症服用碳酸鋰（Lithium carbonate）。護理師應優先提供哪項指導以預防鋰中毒？
A client is taking lithium carbonate for bipolar disorder. Which instruction should the nurse prioritize to prevent lithium toxicity?
- AExercise vigorously to promote drug metabolism劇烈運動以促進藥物代謝
- BTake the medication with a low-protein meal隨低蛋白餐點服用藥物
- CLimit sodium intake to less than 2 grams per day將鈉攝取量限制在每日 2 克以下
- DMaintain a consistent sodium and fluid intake✓ 正解維持穩定的鈉與水分攝取
— Explanation · 中文詳解 —
鋰離子在腎臟的排泄與鈉離子競爭。若鈉攝取量過低或水分流失過多（如流汗、腹瀉），腎臟會回收更多鋰，導致血鋰濃度升高而中毒。因此，病人必須維持穩定的鈉鹽攝取與充足水分（2-3 L/day），不可刻意限鈉。
In the kidneys, lithium excretion competes with sodium. If sodium intake is too low or fluid losses are excessive (for example, from sweating or diarrhea), the kidneys reabsorb more lithium, causing serum lithium levels to rise and leading to toxicity. Therefore, the client must maintain a consistent intake of sodium and adequate fluids (2-3 L/day) and must not intentionally restrict sodium.
✦ 台美臨床差異
美國 NCLEX 題目中，鋰鹽與鈉離子的關係是精神科藥物學的核心考點；台灣臨床上也強調流汗過多時需補充水分。