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Heart failure with preserved ejection fraction — SCE Geriatric Medicine MCQ

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HardCardiovascular medicineHeart failure with preserved ejection fractionSCE Geriatric Medicine

An 80-year-old taking lithium develops diarrhoea, coarse tremor, ataxia and new confusion after gastroenteritis. Her last routine lithium level was therapeutic. What should happen immediately?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: BWithhold lithium and obtain lithium, renal and electrolyte tests now

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

E is correct: the clinical syndrome is compatible with lithium toxicity, which may occur despite a previously or even apparently current therapeutic concentration; lithium is withheld, urgent lithium and renal/electrolyte testing obtained, and specialist advice sought. A delays action. B makes an unmonitored partial adjustment. C worsens toxicity. D tests a chronic adverse effect while ignoring an acute poisoning syndrome.

Reference: NHS SPS: lithium monitoring: https://www.sps.nhs.uk/monitorings/lithium-monitoring/