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With rare exceptions, infants should not be breast-fed while the mother is receiving lithium therapy. Some side effects may occur at serum lithium concentrations below 1. Since plasma lithium determinations immediately after dialysis do not take into account the rebound increase that occurs as lithium redistributes from tissue to blood, determinations must be obtained 6 hours later {45}. 5 to 3 liters of fluid per day, is essential to prevent sodium depletion leading to lithium toxicity {57} {58}. Alternatively, extended-release or slow-release lithium products can improve the patient"s renal concentrating ability. Also, the elderly possibly may be more prone to develop lithium-induced goiter and clinical hypothyroidism. Lithium is more {41} toxic to the central nervous system (CNS) in the elderly, even when serum lithium concentrations are within the therapeutic range for younger adults. If the lower plasma lithium concentration is inadequate to maintain a response, adding a thiazide diuretic and reducing the lithium dose by 50%, then readjusting it to reproduce the original plasma lithium concentration, may be effective.

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