Outline Of Proposed Interventions Of A Play Piano Music...

Summary of proposed interventions This CPI project will consist of one intervention within an RACF. The intervention will be to have a live musician play piano music whilst residents eat lunch in a main, communal dining room in the RACF. The pianist will play a selection of calming and relaxed classical and jazz music in a casual setting for a 90 minute period over lunchtime every day of the week. Whilst the musician may change, the musical styles will always be similar. All residents and their families will be informed of the project and it’s expected outcome, and their consent will be gained. Those who do not wish to be involved in the project will be able to enjoy the lunchtime program, however, no data will be collected from them. Nursing and caring staff will be required to note down the type of behavioural episode, such as verbal or physical aggressive or non-aggressive behaviours, at the time of episode or as soon after as possible. This method of data collection has been shown to be effective in assessing types and frequency of behaviours in residents by Lin et al. (2011, p. 671) and Chang et al. (2010, p. 940). A similar type of documentation may already be in place in the facility. If this is the case, no extra documentation will be required of the staff and an audit will be conducted to collect information; otherwise, appropriate documentation will be provided for staff to complete. This data will be compiled by researchers to determine trends shown over the timeShow MoreRelatedStrategic Marketing Management337596 Words   |  1351 Pageshas been the emergence of what within this book we refer to as ‘the new consumer’ and ‘the new competition’. This new consumer is typically f ar more demanding, far more discriminating, much less loyal and more willing to complain than in the past, whilst xii P R E FA C E the new competition is frequently far less predictable and often more desperate than previously. At the same time, the marketing environment has also been affected by a series of unpredictable events (SARS and the Iraq war

Essay Trinculo in The Tempest by William Shakespeare

Trinculo in The Tempest by William Shakespeare In William Shakespeares The Tempest, Trinculo is a minor comic character whose main ambition is to align himself with whomever is the perceived leader in any situation he finds himself in. He is an intrinsically sociable person, and he gains whatever social rank he can through positioning himself in accordance with those around him, but never seeks to be the leader. In this way, he is the perfect jester, always seeking to stand by the kings side. The trio of Trinculo, Stephano, and Caliban is formed in Act II, scene ii, when first Trinculo, and then Stephano, make their first appearances in the play. When Trinculo comes onstage in line 19, he believes he is†¦show more content†¦However, Trinculos confidence in his position with Stephano is shattered in the trios next scene in Act III, scene ii. Here we see a reversal in the relationship as Caliban works to usurp Trinculos position with Stephano. A power struggle between Caliban and Trinculo evolves comically, with Caliban temporarily achieving the top position next to Stephano, symbolized first by Stephano warning Trinculo to run into no further danger. Interrupt the monster one word further and, by this hand, Ill turn my mercy out odoors and make a stockfish of thee (II.ii.59-61), and then by his beating him when Stephano mistakenly believes Trinculo called him a liar. At this point in the play, Trinculo shows a rare moment of independence and courage when he fights back, telling Stephano, I did not give the lie. Out o your wits and hearing too? / A pox o your bottle! This can sack and drinking do. / A murrain on your monster, and the devil take your fingers! (III.ii.67-69) But Trinculos spurt of independence is short-lived, because Stephano restores the promise of fellowship by saying, Monster, I will kill this man. His daughter and I will be king and queen – save Our Graces! – and Trinculo and thyself shall be viceroys. Dost thou like the plot, Trinculo? (III.ii.94-96) Trinculo eagerly falls back intoShow MoreRelated Essay on the Roles of Trinculo and Stephano in The Tempest863 Words   |  4 PagesThe Roles of Trinculo and Stephano in The Tempest      Ã‚  Ã‚   Trinculo and Stephano have two major roles in The Tempest - comic relief and the theme of exploration. Because of this double nature to their characters, they are more important than they initially appear.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Tempest is a comedy. The play may not seem to fit into the category of comedy as it exists today; but in the 17th century comedy was very different. Certainly, The Tempest would never be confused with a modernRead MoreThe Elizabethan Era1595 Words   |  6 PagesElizabethan Era, theater was being taken to new heights and the unexpected was taking place frequently. Queen Elizabeth had a love for the arts, especially theater written by Shakespeare. 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As John Wilders observes in The Lost Garden, â€Å"Prospero’s island is what the sociologists call a ‘model’ of human society. Its cast of characters allows Shakespeare to portray in microcosm nearly all the basic, fundamental social relationships: those of a ruler to his territory, a governor to his subjects, a fatherRead More tempcolon Confronting Colonialism and Imperialism in Aime Cesaires A Tempest1403 Words   |  6 PagesColonialism in A Tempest   Ã‚  Ã‚   A Tempest by Aime Cesaire is an attempt to confront and rewrite the idea of colonialism as presented in Shakespeare’s The Tempest.   He is successful at this attempt by changing the point of view of the story.   Cesaire transforms the characters and transposes the scenes to reveal Shakespeare’s Prospero as the exploitative European power and Caliban and Ariel as the exploited natives.   Cesaire’s A Tempest is an effective response to Shakespeare’s The Tempest because heRead MoreThe Tempest By William Shakespeare1603 Words   |  7 PagesShakespeare’s play, The Tempest, power is manifested in several forms: the investigation of the power of love, the power of magic and illusion, or the power of nature. However, in The Tempest, power is most clearly defined as dominance. Throughout the play, there is a universal pursuit of dominance over other people, dominance over property, or dominance over cultural ideals. These pursuits of dom inance are used in an attempt to further ones authority, and, ultimately, one’s life. In The Tempest, a motif ofRead More The Tempest: Allegorical to the Bible Essay1161 Words   |  5 PagesThe Tempest: Allegorical to the Bible The Tempest is not a pure fantasy tale, but a purposeful allegory. The characters in the play are all representative of characters found in the bible. The first, and perhaps most persuasive, arguement would be Prospero symbolizing God. Prospero is seen to be a representative of God for several reasons. First, he is obviously in control of the actions and has an omnipotent quality. This has been demonstrated by several scenes throughout the play. ConsiderRead More European Colonization in Shakespeares The Tempest Essay1279 Words   |  6 PagesNo Critique of European Colonization in The Tempest      Since the 1960s, several critics have found a critique of colonialism in their respective readings of Shakespeares The Tempest. The most radical of these analyses takes Prospero to be a European invader of the magical but primitive land that he comes to rule, using his superior knowledge to enslave its original inhabitants, most notably Caliban, and forcing them to do his bidding. While the textual clues concerning the geographic locationRead MoreEssay on Quest for Power In The Tempest1208 Words   |  5 PagesQuest for Power In The Tempest      Ã‚   I suggest that engraved into humanitys essence is the intense desire for power. William Shakespeares play, The Tempest not only depicts this concept, but breaks it down for the reader; enabling effective analysis of this concept. Through notable characterization, Shakespeare is able to convey key concepts regarding the idea of power versus ambition. Specifically, the role that ambition and the moderation of ones ambition play in the effectiveness of control

Essay On Problem Solving Techniques Used By Few Organisations Free Essays

Acknowledgement An old Chinese proverb says; When eating your bamboo sprouts, remember the man who planted them. Now that our sprouts are ready to eat, it is time for us to express our deepest gratitude to all those to have made this possible. We wish to express our sincere gratitude to our professor who guided and helped us from time to time to successfully conduct this research. We will write a custom essay sample on Essay On Problem Solving Techniques Used By Few Organisations or any similar topic only for you Order Now We think her directions were the best thing that could happen to us and our project. We also would like to thank each other of our group members and hope you enjoy reading the report as much as we enjoyed making it. Contents Problem Solving Process Steps Techniques used by various companies to solve their problems. 1) Nokia 2) Cadbury Dairy Milk 3) Tata Nano 4) Bisleri 5) Coca Cola 6) Allwyn photo copiers Problem Solving Process Steps As the owner of your own business you deal with problems on an almost daily basis. Being familiar with effective Problem Solving Techniques can dramatically affect the growth of your business. Although you find solutions to your problems, many businessmen and women are not really skilled in the methods of problem solving, and when solutions fail, they fault themselves for misjudgment. 1. Define the problem Diagnose the situation so that your focus is on the problem, not just its symptoms. Helpful techniques at this stage include using flowcharts to identify the expected steps of a process and cause-and-effect diagrams to define and analyze root causes. 2. Generate alternative solutions Postpone the selection of one solution until several alternatives have been proposed. Having a standard with which to compare the characteristics of the final solution is not the same as defining the desired result. A standard allows us to evaluate the different intended results offered by alternatives. When you try to build toward desired results, it’s very difficult to collect good information about the process. Considering multiple alternatives can significantly enhance the value of your final solution. Once the team or individual has decided the â€Å"what should be† model, this target standard becomes the basis for developing a road map for investigating alternatives. Brainstorming and team problem-solving techniques are both useful tools in this stage of problem solving. Many alternative solutions should be generated before evaluating any of them. A common mistake in problem solving is that alternatives are evaluated as they are proposed, so the first acceptable solution is chosen, even if it’s not the best fit. If we focus on trying to get the results we want, we miss the potential for learning something new that will allow for real improvement. 3. Evaluate and select an alternative Skilled problem solvers use a series of considerations when selecting the best alternative. They consider the extent to which: A particular alternative will solve the problem without causing other unanticipated problems. All the individuals involved will accept the alternative. Implementation of the alternative is likely. The alternative fits within the organizational constraints. 4. Implement and follow up on the solution Leaders may be called upon to order the solution to be implemented by others, â€Å"sell† the solution to others or facilitate the implementation by involving the efforts of others. The most effective approach, by far, has been to involve others in the implementation as a way of minimizing resistance to subsequent changes. Feedback channels must be built into the implementation of the solution, to produce continuous monitoring and testing of actual events against expectations. Problem solving, and the techniques used to derive elucidation, can only be effective in an organization if the solution remains in place and is updated to respond to future changes. Techniques used by various companies to solve their problems. 1) Nokia As we all know, Nokia had for so many years used the symbian operating system in their phones. It was working fine and Nokia had captured the Indian phone market very well. There was no competition to it from left right or centre. But in 2008 came a breathtaking technology by Google. They invented the Android OS. It became a benchmark for the mobile phone companies. Each and every phone started making their phones with the latest android technology, as android was fast, modern and the most important, user friendly. While Nokia still stuck to its old symbian os, and did not use the android technology. Slowly and gradually, Samsung took over the Indian market by storm. They had captured the Indian market which for long belonged to just Nokia. Nokia had a problem here. They did not use the android os because of some internal matters of their organization. So after a good amount of research and development later, nokia came out with a solution that would bring the brand nokia back in the market and try to regain its lost glory. They upgraded their technology and started making phones with the Windows phone 8 OS. These phones gradually caught the eye of the Indian customers,  as it was something different than android. People started purchasing the Nokia Lumia series of phones and the sales of Nokia phones again where on a rise. 2) Cadbury Dairy Milk In eight outlets across Maharashtra, worms were found in some bars of Cadbury Dairy Milk, Cadbury’s bread-and-butter brand selling 1 million bars a day and an icon of ‘chocolate’ in India. Inquiry was instituted by the Food and Drug Administration and negative media publicity spread like wildfire. The extensively graphic media coverage led people to believe that every bar could be contaminated. Consequently, sales volume plummeted, retailer cooperation lessened and employee morale dwindled. All in all, the company’s credibility suffered extensive damage. Reason behind this crisis..After a thorough investigation of the entire supply chain, it was found that the problem originated at the distribution end. Apparently, at the retail outlets the infested bars were placed next to open unpacked items susceptible to worms. However, although the problem was not of its own making, Cadbury did take responsibility for the lack in educating retailers on storage and hygiene. The company launched a new double packaging that wrapped even the smallest 13 gm chocolate in an aluminium foil, heat-sealed for complete protection from all sides and further encased in a polyflow pack. The over-engineered pack, the first of its kind in India, cost the company a fortune, but fulfilled the company’s promise to media and consumers. The new packaging was launched amidst much fanfare in a media conference. Amongst the material distributed in the conference were a comparison kit allowing evaluation of old and new packs and a video new release with packaging and factory shots for television coverage. To reinstate confidence among sales people and to motivate them, another audio-visual with a message from the ambassador Amitabh Bachchan was shown in a string of sales conferences. 3) Tata Nano Until the afternoon of 21 March when he took delivery of his Lunar Silver coloured Nano, 36-year-old Satish Sawant was your average citizen leading a normal life. On the Sunday of 21 March, accompanying him to collect the car  was his wife, five-year-old son and a temporary driver. It was close to 3 pm that day and they were nearing his residence. His wife pointed out that something was burning. Sawant looked out. Nothing was burning. She insisted and forced him to park. He got out—there was smoke coming out of the car’s rear. He hurriedly got his wife and son out. The smoke turned billowing black. He took the car’s papers out. The little vehicle now began to burn like you see in the movies. Tata Motors attributed the first couple of cases to the melting of localised parts caused by faulty combination switches. That is somewhat similar to sparks and smoke in your house’s wiring caused by an electric short-circuit. There was no quality control deployed at the Tata motors production facility. So in order to bring the situation under control and solve this problem, Tata motors changed the vendors who supplied the combination switches and employed a proper quality control in their plant, by which each and every car would go through proper checks before being granted the ok status. 4) Bisleri In the early 1990s, Parle Bisleri Ltd’s (Parle Bisleri’s) Bisleri1 had become synonymous with branded water and had a market share of 70%. In the late 1990s, Bisleri’s market share began to erode with new players entering the market. The Cola majors, Pepsi and Coca-Cola and the confectionery giant, Nestle, also entered the branded water market in India. Pepsi and Coca-Cola had an established distribution network. Bisleri realized that with the new players also clambering on to the purity plank, it had to reposition itself to arrest its declining market share. In September 2000, Parle Bisleri launched its Play Safe ad campaign. The company tried to add a fun element to Bisleri to rejuvenate the brand. The ultimate aim was to increase Bisleri’s turnover from Rs 4 billion2 in 2000 to Rs 10 billion by 2003. In 2001, both Kinley and Aquafina were making huge investments in bottling plants and distribution. By 2002, Coca-Cola India planned to double the number of water bottling plants to 16 and Pepsi announced that it would add seven more plants to the existing five. In contrast, Bisleri had only 15 bottling plants and three franchisees. Kinley had 500,000 outlets compared to Bisleri’s 350,000. Analysts felt that Kinley and Aquafina had an edge over Bisleri because of their strong distribution network. In 2000, in the  face of competition from the new entrants, Bisleri decided to penetrate every possible segment of the market by introducing more pack sizes and to establish the brand strongly with trendy packaging. In 2000, Bisleri launched the 1.2 litre pack. This added to the five pack sizes that Bisleri had (500 ml, one, two, five and 20 litres). The new pack was priced at Rs 12. In 2000, Bisleri also launched smaller packs like the 300 ml cup. This 300 ml cup was targeted at large gatherings like marriages and conventions. A study conducted by Bisleri showed that its one litre pack was not considered trendy enough. 5) Coca Cola In 2003, the Centre for Science and Environment (CSE), a non-governmental organisation in New Delhi, said aerated waters produced by soft drinks manufacturers in India, including multinational giants PepsiCo and Coca-Cola, contained toxins including lindane, DDT, malathion and chlorpyrifos — pesticides that can contribute to cancer and a breakdown of the immune system. Tested products included Coke, Pepsi, and several other soft drinks (7Up, Mirinda, Fanta, Thums Up, Limca, Sprite), many produced by The Coca-Cola Company. This affected the sales of cocacola to a great extent, they went crashing down. Later on after a detailed study, the company found out that the water they used for the manufacturing was safe and free from pesticides, but the problem was in the packaging department. The bottles in which the coke is to be filled is processed and cleaned with certain chemicals so that it becomes safe and all the impurities are removed, and later on the bottle is washed with water. It was seen that after cleaning the bottles with the chemicals, they were not being washed properly, which resulted in the chemicals staying in the bottle before the coke was filled in it. The company identified this problem and resolved this by keeping a proper quality control on the bottling plant and make sure that the bottles are washed properly after being treated with chemicals. 6) Allwyn photo copiers This is a shop which is situated in Mumbai. It undertakes the work of photo copying, printing, etc. For years they have been using the old Xerox machines. The name Xerox is synonym with photo copy in India. But as the  time changes, there is a need to adopt new technologies to keep up with the competition in the market. So the company purchased new equipments and new printers which had the latest technologies like laser beam printing, etc. But after purchasing and using the new equipments, instead of their sales going up, they started declining. This was a matter of concern for the management as the sales were declining even after they were using the new technologies. They did a proper research on this and found out that the problem was not in the machinery, but the people handling the machines were not aware of the new machines properly and thus they were not able to use it efficiently. To overcome this problem, the management decided to train the employees who handle the machines. They were trained on various aspects as to how to make full use of machiniery with minimum efforts. Training the workmen is an important part of the production process. Thus when the handlers were trained properly, they knew how to use the machines properly and this in turn increased their efficieny. This resulted in more sales and more productivity. Conclusion Thus we saw the case studies of various organizations and companies and how they overcome their problems. We can take a few inputs from these cases and implement it whenever we are stuck in any problem similar to these. Quality control and problem solving techniques are extremely important for an organization , as each and every organization faces some kind of the problem. What is important is that how they overcome it. How to cite Essay On Problem Solving Techniques Used By Few Organisations, Essays

Lithium Clinical Considerations in Internal Medicine

Question: Discuss about the Lithium Clinical Considerations in Internal Medicine. Answer: Introduction Lithium is the third element of the periodic table which shares certain properties with elements such as sodium and potassium (1, 2, 14). Lithium is majorly used in the hospital for treatment of mental disorders specifically as the mood stabilizer in treatment and maintained of bipolar diseases (1, 2, 3, 4, 12, 14, 16). The effectiveness of therapy of bipolar disease was discovered in 1949. In addition, lithium has remained as a drug of choice in bipolar treatment as it is said to reduce the risk of suicide in such patients (4, 6, 9). Furthermore, lithium is used in the treatment of depression, schizophrenia, schizoaffective disorder and other mental illnesses (1, 2, 3, 6, 7, 8). This drug profile seeks to demonstrate the mechanism of action, side effects and toxicity, clinical uses, drug formulation, chemical structure, pharmacokinetics, requirements for therapeutic drug monitoring and consideration when using lithium in special population. Mechanism of Action The specific mechanism of action of lithium is not well known especially as a mood stabilizer (2, 4, 7, 9, 12,). Lithium can alter the sodium transport across the cell membranes of the nerves; it can also alter serotonin and catecholamine metabolism and intracellular signaling using the second messengers (9). Lithium can also reduce proteins kinase C activity which can affect genome expression associated with neurotransmission (12). Lithium may increase cytoprotective proteins activating a cascade of growth factors that might increase the gray matter and in that matter enhancing neurogenesis activation and trophic actions that usually maintains synapse (12). Mediated by monoamine neurotransmitters, lithium can change synaptic transmission and in that case increasing the time of the presynaptic destruction of catecholamines thus inhibiting transmitters release at the synapse and reducing postsynaptic receptor sensitivity (9, 12). Various studies have shown that lithium has a tendency of increasing the release of serotonins by brain neurons. By inhibiting 5-HT1A and 5HT1B receptors, lithium has demonstrated to enhance the release of serotonin to the synapse making it have an antidepressant effect (6). Lithium has also be seen to interact with Nitric Oxide which in turns signals the pathway in the neural system that plays a significant role in neural plasticity (12, 13). Through modulation of glutamate levels, lithium is also believed to provide long-term mood stabilization. This is due to its competing actions with magnesium towards glutamate receptors. During the manic episodes, there is a rise in dopamine transmission that when regulated using hemostasis can lead to depression (12, 16). The G-proteins receptors are typically responsible for postsynaptic actions of dopamine. In that case, lithium is believed to alter some G-proteins sub-units that are associated with dopamine as part of the mechanism of actio n (12). Adverse effects/ Toxicity The most common adverse effects of Lithium with occurs in more than ten percent of all treated patients include headaches, hyperreflexia which involve a patient having highly responsive reflexes, muscle weakness, increase in number of white blood cells, nausea, muscle twitching, increase thirst and urination , weight gain, vertigo, confusion, low memory, constipation, diarrhea, and hand tremors ( 1, 2, 8, 11, 15,). Other adverse effects occur between 1-10 % of patients treated with lithium which includes hypothyroidism, acne, hair loss, extrapyramidal side effects like muscle rigidity and parkinsonism and goiter (1 2, 3, 4 , 5 8, 9, 14, ). There are others side effects that are very rare and mostly occur below 1 % of all patients treated with lithium which include seizures, edema, renal toxicity, sinus node dysfunction, coma, Brugada syndrome which is a heart conduction abnormality, elevated levels of magnesium, calcium, thyroid and parathyroid hormones and rise in intracranial press ure (1, 3, 13, 15, ). Clinical Uses The primary and most common clinical uses of lithium are in bipolar disorders where it is used as a mood stabilizer( 1, 2, 3, 4, 5, ). Lithium is normally used in acute manic episodes, bipolar prophylaxis, and treatment of acute bipolar depression. In acute manic episodes, lithium can be used to stabilize the mood of patients without combining with other adjunctive treatments like the use of benzodiazepines or antipsychotics (13). In acute bipolar depression, Lithium can be utilized as a first line treatment as a mood stabilizer without even using antidepressants. Antidepressants are only combined with lithium when a fast effect is required ( 8). When acute episodes of bipolar disorders dissolve, lithium is continued as a prophylaxis drug of choice. In addition, Lithium can be used for the treatment of resistant depression as an augmentation of antidepressants ( 14). Other than that, lithium uses has demonstrated to reduce suicidal attempts in bipolar disease. Dosage and Available Formulation The usual form of Lithium medicine in tablet form which are in different milligrams. Some of the common milligrams include 300mg, 150mg, 450mg and 600mg. Lithium can also be in a vial of 5 milliliters which contains 300mg of lithium (4, 5,). The dosage of Lithium is prescribed according to the condition and the age of the patient. Adults or anybody above 12 years receive a full dose as compared to children below 12 years (4, 5). The usual adult dose for patients suffering from acute mania is 1800mg per day with regular doses of 600mg orally divided into three times a day and an extended dose of 900mg orally twice a day. The long-term control of mania includes a maintenance dose of 900mg per day and a conventional formulation of 300mg orally four times a day( 4, 5) . The usual treatments for adulthood in bipolar disease are similar to that of acute mania. However, dosing must be given in accordance to response to treatment and lithium serum levels (5). In addition, there is an alternative treatment dose in the extended formulation of 600mg four times a day for long-term control (5). The dosage for pediatrics over 12 years is also similar to that of an adult ( 4). The only difference is on alternative extended formulation where the dosage is reduced to 300mg four times a day in long-term control (5). In severe renal impaired patients, only the extended release formulations can be given. It is important to avoid lithium in pregnancy where possible (5). Chemical Structures Related to Pharmacokinetic Parameters Li+ b) Li2CO3 Above a) is the chemical structure of Lithium which commonly occurs as Lithium carbonate with a chemical structure shown at b) (6) Lithium ion is absorbed completely in the gastrointestinal tract. The complete absorption takes place in about first 8 hours where the peak concentration in the serum starts at about 2 to 4 hours on an oral dose (7). Due to slow release preparations of lithium carbonate, there is a much slower rate of absorption which readily decreases the early plasma serum peak. Lithium ions are first distributed to extracellular fluids before it enters into the tissues (7). Other structures of lithium salts that can be used as drugs include Lithium lactate and lithium salicylate as shown in the below figures respectively (7). Lithium Lactate and Lithium salicylate The lithium lactate when absorbed in the gastrointestinal tract reach in the plasma levels at 2 hours but the peak is usually at 24 hours, and it is later eliminated rapidly (8). Lithium salicylate, on the other hand, reaches the peak by 48 hours and it is eliminated slowly(8). A study was done by Smith et al. showed that lithium carbonate normally has a larger bioavailability as compared to the high other Lithium salts( 8). Interesting pharmacokinetic parameters and clinical implications In slow and controlled release forms of lithium, the serum pick period after absorption in the gastrointestinal tract is about 4 to 5 hours(13,15). However, Lithium is rapidly absorbed in regular preparation with serum levels peaking at around 2 hours. Since the drug is not metabolized in the liver, it is not highly affected by the first past effect in the alimentary canal (14). Different from other antipsychotic agents, Lithium has no metabolites or clinically crucial binding properties to proteins (9). The renal clearance of the drug is about 20% of the creatinine clearance since most of the Lithium is reabsorbed in proximal convoluted tubules. Lithium is almost entirely excreted by the kidney but there some small traces excreted through feces and sweat(2,3,). The elimination half-life of lithium is about 24 hours. The half-life in elderly patients is a bit longer due to a decrease infiltration rate at Bowmans capsule and shorter in youths (3). The drug has no protein bound charact eristic, and around 80% is reabsorbed in proximal convoluted tubules( 1). The levels of Lithium in serum usually increase when the sodium levels decrease in serum which is accelerated during dehydration(1,3). Requirement for Therapeutic Drug Monitoring (TDM) A report was written by Ratanajamit et al. in 2008 indicated there was appropriateness for therapeutic drug monitoring of lithium between 2004 and 2005 lithium treatment of psychotic disorders (3). The study showed that of all the participants 41.8 % had suspected toxicity, there were about 27% who required various tests without specific indications, serum lithium levels were reported in 91. 2% of all patients who had not taken lithium drug for about five days during the treatment period(3). In addition, 44. 6% of these required dosage alterations (3). Before giving the Lithium treatment, certain parameters such complete blood count, electrocardiograph, baseline creatinine levels and thyroxin stimulating hormones should be checked. Lithium used if the first term of pregnancy has been associated with Ebstein anomaly where 1 out of 1000 is affected and therefore should be monitored during pregnancy(1, 14). The patients under treatment using lithium should receive regular serum levels test, kidney function test, and thyroid hormones levels as they interfere with water and sodium regulations in the body(9,16). This is the major and underlying cause of dehydration in patients under lithium treatment. The dehydration in the body normally increases the lithium levels(8). This dehydration is primarily brought by inhibition of antidiuretic hormone by increase in lithium levels thus inhibiting water reuptake in the kidney(11,13). This in turn led to the loss of water exhibited by thirst. The monitoring of lithium can be performed by measurin g lithium concentration in serum, blood, and urine and use the results as a guide to therapy. The standard serum concentration of Lithium is usually between 0.5 to 1.4 mmol/l (4). When it accumulates over a certain duration of time, mostly after five days, the level increases up to between 1.8 to 2.5mmol/l. During an overdose, the levels can go up to 3 to 10 mmol/l (4). At this time, the dosage required should be adjusted, and the patient monitored in facilities where plasma ratio can be easily be seen (5). Dosages are adjusted to achieve the normal values which are usually to lower in aged patients and to increase in young patients (5). Factors that indicate that lithium is in accordance with the correct therapy and normal values include the absence of adverse effects, no psychosis, and classic mania (16). Consideration of Lithium in Special Population In renal dose adjustments, mild and moderate renal problems do not need any adjustments to the dosage. However, severe renal problems require only the extended release formulation where small doses are started slowly with close monitoring of toxicity (4, 5). The immediate release formulations are contraindicated in severe renal dysfunction. The serum levels should be checked prior to the next dose (4). This is commonly done between 10 to 12 hours from the previous dose. The acute episodes of increase in lithium levels are determined, and dose changed after three days. The long term dose adjustment can be changed after two months (5). Caution should be taken and doses adjusted in patients suffering from cardiovascular disorders (4,5). Lithium should be avoided in pregnancy as it causes cardiovascular problems, especially in the first trimester (1). In infants, lithium should be avoided as it causes drowsiness, cardiac and other permanent side effects to a child(2). Weight gain is a ma jor adverse effect of lithium since it has some metabolic effects on carbohydrates (2, 9). In that case, caution should be taken in obese patients as lithium will normally increase weight. Extended releasing formulations should be used (13) References Lithium: Clinical Considerations in Internal Medicine . Available from: https://www.sciencedirect.com/science/article/pii/S0002934305010582 Oruch R e. Lithium: a review of pharmacology, clinical uses, and toxicity. 2015. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24991789 Ratanajamit C e. Appropriateness of therapeutic drug monitoring for lithium. 2013. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17205880 Lithium: Drug Uses, Dosage and Side Effects , 2017. Available from: https://www.drugs.com/lithium.html Lithium Dosage Guide with Precautio, 2017. Available from: https://www.drugs.com/dosage/lithium.html LITHIUM AMIDE | H2LiN . 2017. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/lithium_amide#section=Chemical-Vendors Lithium DrugBank 2017 [Internet]. Available from: https://www.drugbank.ca/drugs/DB01356 Smith A, Kim S, Tan J, Sneed K, Sanberg P, Borlongan C et al. 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