Patients vary widely in susceptibility to lithium side effects. While most of the serious adverse effects are associated with toxic serum levels, mild side effects such as gastrointestinal distress, dry mouth, excessive thirst, fine tremors, mild polyuria, and peripheral edema are often seen even when serum levels lie within the designated therapeutic range. This is particularly common during the first few weeks of therapy. Many of the more chronic side effects, including polyuria, nephrogenic diabetes insipidus, benign diffuse goiter, hypothyroidism, skin rashes and ulcerations, psoriasis, and leukocytosis without a left shift, appear unrelated to serum lithium levels. Underlying neurologic illness, dehydration, salt-restricted diets, and childbirth predispose to both minor and major side effects.
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