An adult is taking Lithium for bipolar disorder and you plan to discuss toxicity warning signs with the patient. Toxicity warning signs include:

Lithium is a narrow therapeutic index medication commonly used for bipolar disorder to stabilize mood and prevent manic and depressive episodes. Because the difference between therapeutic and toxic levels is small, patients require careful monitoring of serum levels, renal function, and clinical symptoms. Toxicity can develop gradually or suddenly and may be triggered by dehydration, drug interactions, or impaired renal clearance. Early recognition of toxicity signs is critical to prevent serious neurologic and systemic complications. Rationale: A. A new or worsening tremor is an early sign of lithium toxicity. With Lithium, mild fine tremors may occur at therapeutic levels, but progression to coarse tremors suggests increasing serum concentration and potential toxicity. This symptom reflects early neuromuscular involvement and requires prompt evaluation of serum lithium levels. B. Nausea and vomiting are common gastrointestinal manifestations of lithium toxicity. As serum levels of Lithium rise, GI irritation occurs early and may precede more severe neurologic symptoms. These symptoms should not be dismissed as routine side effects when they are persistent or worsening. C. Confusion is a serious neurologic sign of lithium toxicity indicating central nervous system involvement. Elevated levels of Lithium can impair cognitive function, leading to disorientation, lethargy, and in severe cases, seizures or coma. This is a late and potentially life-threatening manifestation requiring urgent intervention. D. All options are correct because tremor, nausea/vomiting, and confusion are all recognized clinical signs of lithium toxicity. With Lithium, toxicity affects multiple body systems including gastrointestinal, neurologic, and neuromuscular systems. Recognizing the full spectrum of symptoms is essential for early detection and prevention of severe complications.