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
One can only report the result and a hard nosed version of the
therapeutic and toxic etc range as:
a. The hypomanic patient doesn't need the drug as he knows better!
&
b. The depressive patient can't be bothered to take it!
Thus compliance is a major problem and one hopes (!!?) that the
clinician who made the request has the common sense to realise the nub
of the problem with the knowledge that Lithium has a narrow therapeutic
range. If he/she can't grasp this perhaps a chat with the RCPsych would
be in order.
--
Dr Henry Chandler
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