What blood tests should be monitored for patients on lithium?
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What blood tests should be monitored for patients on lithium?
Key Points. Baseline testing for lithium includes electrolytes, creatinine, GFR, BUN, thyroid function tests, EKG, CBC, and weight. Tests should be monitored every 4 to 6 months and more often in elderly patients and those with cardiovascular disease.
Is lithium hard on your kidneys?
Lithium may cause problems with kidney health. Kidney damage due to lithium may include acute (sudden) or chronic (long-term) kidney disease and kidney cysts. The amount of kidney damage depends on how long you have been taking lithium.
What labs do you check before giving lithium?
Before starting lithium obtain baseline complete blood cell counts with differential (CBC with diff); urinalysis; blood urea nitrogen; creatinine; serum calcium levels; thyroid function tests; and pregnancy test for females of childbearing age. Monitor for lithium toxicity at every visit.
What lab values indicate lithium toxicity?
A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher. Severe lithium toxicity happens at a level of 2.0 mEq/L and above, which can be life-threatening in rare cases.
Is lithium nephrotoxic?
Lithium nephrotoxicity can be divided into three main categories: nephrogenic diabetes insipidus, acute intoxication, and chronic renal disease. Nephrogenic diabetes insipidus (NDI) is the most common renal side effect of lithium therapy.
At what GFR Should lithium be stopped?
International nephrology guidelines recommend discontinuation of LT in patients with a GFR < 60 ml/min per 1.73 m2, with the majority showing improvement or stabilisation of renal function when lithium therapy is discontinued at a renal clearance of 40 ml/min (Presne et al. 2003; Lepkifker et al. 2004).
Does lithium raise creatinine levels?
Background: Lithium has been shown to increase serum creatinine levels in a subgroup of patients. However, lithium-induced increases in serum creatinine have not been well studied with regard to timing, trajectory, or predictability.
Does lithium affect sodium levels?
The long term use of lithium salts might have influenced the sodium levels of our patients, and the hyponatremic blood level may have caused lithium intoxication (6).
What are the signs of lithium toxicity?
In mild lithium toxicity, symptoms include weakness, worsening tremor, mild ataxia, poor concentration and diarrhea. With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge (Bauer and Gitlin 2016).
Is there a blood test for lithium levels?
The lithium test is used to measure and monitor the amount of lithium in your blood so that a healthcare practitioner can determine whether the drug blood level is within the range that will adequately treat your bipolar disorder (therapeutic range).
What electrolyte should be monitored with lithium?
Calcium levels: A serum calcium level should be checked yearly as lithium may cause hypoparathyroidism. Kidney tests: A BUN and creatinine (kidney function tests) should be drawn at the beginning of treatment, regularly during treatment, and if any symptoms of kidney disease become evident.
Which electrolyte imbalance correlates with lithium toxicity?
Treatment with lithium can lead to renal problems and electrolyte problems, and low sodium levels can lead to higher lithium levels and lithium toxicity. Hence, in screening candidates for lithium therapy as well as those on lithium therapy, checking electrolytes is indicated.
Why does lithium damage the kidneys?
Polyuria and polydipsia are common adverse effects of lithium (30% to 80%), and they are not always benign. When severe, they may indicate nephrogenic diabetes insipidus (NDI), which means that changes in the renal tubules are impeding the kidneys ability to concentrate the urine.
How common is kidney failure with lithium?
Although several reports suggest little effect of lithium on renal function, other studies estimate prevalence of chronic kidney disease (CKD) amongst lithium users between 10 and 35% (Presne et al. 2003; Lepkifker et al. 2004; Bassilios et al. 2008; Bendz et al.
Can lithium lower GFR?
Long-term lithium treatment was associated with gradual decline of renal functioning (eGFR) by about 30% more than that was associated with aging alone. Risk of subnormal eGFR was from 18.1% (≥2 low values) to 29.5% (≥1 low value), requiring about 30 years of exposure.
How does lithium affect potassium levels?
It can cause hypercalcemia, decrease intracellular potassium, thus interfering with impulse propagation and depolarization which manifests as ST, T changes on ECG. It was proposed that lithium interfering with potassium can cause intracellular hypokalemia and extracellular hyperkalemia.
Does lithium affect potassium levels?
When should lithium levels be checked?
Lithium testing should take place 10 to 12 hours after your last dose of the medication. Sample collection most often takes place in the morning before you take the next dose of lithium. Generally, no other special test preparation is needed.
