Long-term lithium needs more than a generic med-management note. Serum levels trend. Creatinine, eGFR, and TSH need periodic review. Tremor, polyuria, weight, and cognitive blunting shift visit to visit. The dose decision is the trend, not a single number.
Built for psychiatrists and psychiatric NPs following bipolar patients on lithium. Level history, lab interval, and side-effect trajectory have their own fields. Fits a 20-minute stable check and a longer visit when a level is out of range. The Lithium tag keeps the panel filterable for lab-cycle management.
Patient: [patient_name] DOB: [dob] Age: [age]
Date: [encounter_date] Provider: [provider_name] Duration: [duration]
Diagnosis: [icd10] (bipolar I, bipolar II, schizoaffective, augmentation for MDD)
Lithium formulation and dose: immediate-release / extended-release, total daily dose
Years on lithium: [years_on_lithium]
Subjective
- Mood interval (euthymic, depressive, hypomanic, mixed):
- Sleep, energy, concentration, racing thoughts:
- Adherence (missed doses, timing, with food):
- Lithium side effects:
- Tremor (fine, coarse, functional impact):
- Polyuria, polydipsia, nocturia:
- Weight change:
- GI symptoms (nausea, diarrhea):
- Cognitive complaints (slowing, word-finding):
- Cutaneous (acne, psoriasis):
- Hypothyroid symptoms (cold intolerance, fatigue, weight gain):
- NSAID, ACE inhibitor, ARB, diuretic, dehydration, fever, low-sodium diet (interaction risks):
- Recent illness or hospitalization:
- Substance use:
- Pregnancy status if applicable:
Objective
- Vitals (BP, HR, weight):
- Mental status exam:
- Tremor exam if performed:
- Lithium level
- Most recent: [level] mEq/L Drawn: [draw_time] Trough timing confirmed: yes / no
- Trend across last four levels:
- Recent labs
- Creatinine, BUN, eGFR (with trend):
- TSH (with trend), free T4 if indicated:
- Calcium (PTH if indicated):
- CBC, electrolytes, urinalysis if indicated:
- Last ECG (if older patient or new cardiac symptom):
Risk assessment
- Suicidal ideation:
- Toxicity risk indicators (level approaching 1.2, dehydration, recent NSAID start):
Assessment
- Mood stability across interval:
- Lithium therapeutic range adequacy:
- Renal trajectory:
- Thyroid status:
- Side-effect tolerability:
- Diagnostic update if any:
Plan
- Lithium dose continued:
- Lithium dose adjustment (with rationale and target level):
- Next lithium level: [date]
- Next renal panel and TSH: [date]
- Other labs ordered:
- Concurrent medications continued or adjusted:
- Patient education (hydration, NSAIDs, sodium intake, illness sick-day rules):
- Coordination with PCP for renal and thyroid:
- Safety planning if relevant:
- Follow-up interval:AriaMD pulls lithium, renal, and thyroid trends into the note so the dose decision references the trend. Side-effect language stays in its field. NSAID starts, new ACE inhibitors, and low-sodium diets get flagged when they come up. The Lithium tag keeps the panel filterable for quarterly lab-cycle review.