一位患有第一型雙極性疾患（躁鬱症）的病人在躁期發作住院後準備出院。護理師在進行鋰鹽（Lithium）治療指導時，應包含下列哪項說明？
A client is being discharged after a psychiatric hospitalization for a manic episode of Bipolar I Disorder. The nurse should include which instruction when teaching about Lithium therapy?
- ARestrict your sodium intake to prevent drug toxicity.限制鈉攝取量以防止藥物中毒。
- BTake the medication only when you feel your mood starting to lift too high.僅當您感覺情緒開始過度高漲時才服藥。
- CStop taking the medication immediately if you feel fine for more than a week.如果您感覺良好超過一週，請立即停止服藥。
- DDrink at least 2 to 3 liters of fluid daily and maintain consistent salt intake.✓ 正解每天至少飲用 2 至 3 公升液體，並保持恆定的鹽分攝取。
鋰鹽治療的安全性取決於體內電解質與水分的平衡。鋰離子與鈉離子在腎臟競爭排泄，當體內鈉離子降低（如低鹽飲食、大量出汗）或水分不足（脫水）時，腎臟會增加對鋰的重吸收，導致血鋰濃度上升引起中毒。因此，核心原則是『維持恆定』。選項 D 正確地指出需要充足的水分（2-3公升）和穩定的鹽分攝取，以避免血藥濃度波動。選項 A 是常見錯誤，限鈉反而會導致鋰中毒。選項 C 和 B 反映了病人對長期用藥的依從性問題，鋰鹽需長期穩定服用以預防發作，不可自行停藥或隨機服用。
The safety of lithium therapy depends on a stable balance of electrolytes and fluid. Lithium and sodium compete for excretion in the kidneys; when sodium levels fall (for example, due to a low-salt diet or heavy sweating) or fluid intake is insufficient (dehydration), the kidneys reabsorb more lithium, raising serum lithium levels and risking toxicity. The core principle is therefore to keep intake consistent. Option D correctly notes the need for adequate fluid (2-3 L daily) and a stable salt intake to avoid fluctuations in serum drug level. Option A is a common misconception; sodium restriction can actually lead to lithium toxicity. Options C and B reflect adherence problems for long-term therapy; lithium must be taken consistently to prevent relapse and should not be stopped or taken on an as-needed basis.
在美國，鋰鹽中毒的法律訴訟風險較高，護理師在衛教時會強調抽血監測（Lab monitoring）的法律與臨床必要性。台灣臨床上，護理師則常需要花更多時間與家屬溝通「鋰鹽不是安眠藥或鎮定劑」，並處理家屬對長期服用精神科藥物對腎臟損傷的擔憂。