In message
<[log in to unmask]>, Woods
Angela (RWG) West Hertfordshire TR <[log in to unmask]> writes
>It would be helpful to know what other Labs quote for this. My own view is
>that we should be cautious and quote a narrow range for prophylaxis (eg 0.4
>- 0.8mmol/L) as this covers the majority of patients safely. Severely
>disturbed/manic patients may need higher levels, but I would expect
>specialist medical staff to realise this and treat the patient rather than
>the result. The Pharmacist at a local secure Unit is worried that doctors
>will actually treat the result, and inappropriately reduce doses in violent
>patients with Li levels of, say 0.82mmol/L if it is flagged as "high". She
>feels that it would be dangerous for her to tell them to effectively ignore
>the flagged result, as they may then ignore a flagged potassium.
>We can each see the other's point of view. How do other Labs cope?
>Looking forward to hearing from you.
>Angela
>
>ACB Web Site
>http://www.acb.org.uk
>List Archives
>http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
>List Instructions (How to leave etc.)
>http://www.jiscmail.ac.uk/
>
I think you should quote whatever you think the best evidence supports
(the levels you quote for a 12 hour sample are fairly typical).
Whatever you do you will find that the psychiatrists will have their own
protocols which they will follow whatever you quote (and whatever the
pharmacists say) so you should involve them in your discussions. If you
want to be safe you can add a rider that the level should be interpreted
in the light of symptoms of disease and potential toxicity, or some
similar wording, which we also use when reporting anticonvulsant levels,
which should also be interpreted in light of patients condition and
symptoms of toxicity. Therapeutic ranges are a trap for the unwary
because of individual variation in biological effect and drug metabolism
and for some drugs e.g. carbamazepine, are quite a poor guide.
--
Trevor Gray
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|