Serum Lithium monitoring in non-psychiatric wards in a university hospital
- PDF / 145,674 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 91 Downloads / 159 Views
LETTER TO THE EDITOR
Serum Lithium monitoring in non-psychiatric wards in a university hospital Jahan Zeb Khan 1 Received: 10 November 2020 / Accepted: 18 November 2020 # Royal Academy of Medicine in Ireland 2020
Lithium is recommended for the acute treatment of mania and prophylaxis in bipolar disorder and to augment antidepressants in treatment-resistant depression. Its use for these indications is supported by UK treatment guidelines [1–3]. For most patients, treatment with lithium is long term [4]. The therapeutic range for lithium is between 0.4 and 1.0 mm/l [5]. Increasing levels above this upper threshold are associated with signs and symptoms of lithium toxicity such as confusion, seizures, and renal damage [6]. Lithium treatment increases the risk of clinical hypothyroidism up to 5-fold, through complex mechanisms that are unrelated to dose [5]. These potential problems necessitate pre-treatment checks of renal and thyroid function, followed by regular checks for the duration of lithium treatment for all patients. It is important to monitor lithium in the patients being admitted to medical wards due to high risk of lithium toxicity in patients with dehydration, renal impairment, or interaction with other common medications, e.g., NSAIDs and ACE inhibitors [7]. The National Institute of Clinical Excellence (NICE) guideline for bipolar disorder [3] recommends that serum lithium is checked every 3 months in the first year and in patients at higher risk of lithium toxicity while the British Association for Psychopharmacology (BAP) guidelines for bipolar disorder [1] also recommend every 3 to 6 months check. This audit followed hospital protocols of checking serum lithium on admission to medical wards and it is in line with above-mentioned guidelines by the NICE and BAP.
* Jahan Zeb Khan [email protected] 1
St Patrick’s University Hospital, Dublin, Ireland
Methods The hospital electronic record of patients was used to identify their date of admission and most recent blood test with regard to the admission date. The patients who were on lithium were identified by a psychiatry pharmacist who dispenses lithium. The first cycle of the audit was carried for all patients admitted to different specialities other than psychiatry, between May 2018 and August 2018, and a total of seventeen patients (n = 17) were identified who were on lithium, while the second cycle was conducted for patients admitted between September 2018 and December 2018 and a total of fifteen patients (n = 15) were identified. This audit only includes patients who were on lithium for the psychiatric indication but admitted to medical, surgical, and other non-psychiatric wards due to acute medical issues unrelated to psychiatry. This is due to the reason that the aim of the study was to assess standards of serum lithium monitoring in non-psychiatric wards.
Results In the first cycle of the audit, we reviewed blood test results of seventeen (n = 17) patients. Out of seventeen, only four patients (23.5%) had their serum lithium checked
Data Loading...
