TOPICS: Lithium, unclear mechanism, bipolar disorder, acute manic episodes, goitrogen, inhibits t3 and t4 release, teratogenic, narrow therapeutic window, acute toxicities, gi distress, nausea, vomiting, diarrhea, ataxia, slurred speech, tremors, confusion, seizures, hyperreflexia, aggressive isotonic nacl, nephrogenic diabetes insipidus, hypothyroidism, excreted by kidneys, monitor bun/cr, monitor serum lithium levels, reabsorbed in pct, elderly patient have increased risk of lithium toxicity, volume depletion, drugs that decrease renal clearance, thiazides, nsaids, ace inhibitors, cirrhosis, heart failure