<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 25-year-old man is brought to the emergency department by his fiancée for altered mental status. She states that they got in a fight that morning. She later got a text from him at work that said he was going to kill himself. She rushed back home and found him unconscious on the living room floor surrounded by his prescription pill bottles. The patient is sedated but conscious and states that he thinks he swallowed a bunch of pills about 2 hours ago. He also complains of nausea. The patients medical history is significant for bipolar disorder and chronic back pain from a motor vehicle accident. He takes lithium and oxycodone. The patients temperature is 99F 37.2C, blood pressure is 13078 mmHg, pulse is 102min, and respirations are 17min with an oxygen saturation of 97 on room air. On physical exam, the patient is drowsy, and his speech is slurred, but he is fully oriented. He has horizontal nystagmus, is diffusely hyperreflexic, and has a mild tremor. His initial electrocardiogram shows sinus tachycardia. Labs are obtained, as shown below:Serum:Na: 143 mEqLK: 4.3 mEqLCl-: 104 mEqLHCO3-: 24 mEqLBUN: 18 mgdLCreatinine: 1.5 mgdLGlucose: 75 mgdLLithium level: 6.8 mEqL normal 0.6 mEqL 1.2 mEqLAn intravenous bolus of 1 liter normal saline is given. Which of the following is the next step in management?? A: Activated charcoal, B: Gastric lavage, C: Hemodialysis, D: Naloxone, E: Sodium bicarbonate,  <response>: This is a question about the management of acute lithium toxicity in a patient who has overdosed on lithium and other medications. The key findings are the elevated lithium level of 6.8 mEqL, which is toxic, along with symptoms of lithium toxicity including nausea, altered mental status, nystagmus, hyperreflexia and tremor. The question asks about the next step in management after giving 1L of normal saline, which helps promote lithium excretion. The choices include gastric decontamination with activated charcoal or gastric lavage, hemodialysis to remove lithium, naloxone which reverses opioid overdose, and sodium bicarbonate which can be used to treat acidosis from lithium toxicity.C: Hemodialysis 