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Diabetic kidney disease — CCFP MCQ

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HardChronic disease managementDiabetic kidney diseaseCCFP

A 72-year-old on stable lithium develops coarse tremor, ataxia and confusion after diarrhea and new hydrochlorothiazide use. Creatinine has doubled. What is the safest immediate plan?

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Correct answer: E — Hold lithium and hydrochlorothiazide and obtain urgent toxicology assessment

Explanation lettering: C = shown as A · A = shown as C

E is correct. Neurologic symptoms, dehydration, kidney injury and thiazide exposure strongly suggest chronic lithium toxicity; both drugs are withheld and urgent monitored assessment determines fluids and possible dialysis. A delays treatment. B uses a decontaminant that does not bind lithium. C further reduces lithium clearance. D prioritizes a chronic adverse-effect test over an acute poisoning. A single level must be interpreted with timing, symptoms and renal trajectory.

Reference: Ontario Poison Centre: Lithium poisoning: https://www.ontariopoisoncentre.ca/siteassets/pdfs/english/patient-care-resources-documents/lithium-patient-care-resource-feb-2026.pdf