Pregnancy test

X

X

In women of childbearing age.

Category D. 0.1-0.7% absolute risk of Ebstein’s anomaly of tricuspid valve (normal population = 0.01%).

Complete blood count

X

X

Most frequently benign leukocytosis >15 K white blood cell count (WBC)/mm³.

Reverses with discontinuation. Exclude infection.

Blood chemistries (including renal tests)

X

X

X

Discontinue if fluctuating or unstable renal function and consult with medicine/nephrology.

ECG

X

X

X

Indicated in patients >40 years and/or history of cardiac disease.

Discontinue with sinus disease or conduction defects.

May reveal transient T wave inversion/flattening that often normalizes with either continuation or discontinuation of lithium.

Urinalysis

X

X

Management of lithium-induced nephrogenic diabetes insipidus (often reversible if lithium discontinued).

1. Increase fluid intake.

2. Consider K 10-20 mEq/d.

3. Consider thiazide (caution), amiloride (non-thiazide & preferred) 5-10 mg p.o. BID.

4. Discontinue lithium.

5. Continue electrolyte monitoring. If lithium must be continued, decrease to lowest effective dose & QD if able.

Monitor lithium level minimum q 2 months.

Proteinuria indicative of glomerular & tubule damage.

Thyroid function tests

X

X

Increased risk in women & rapid cyclers. Usually reversible hypothyroidism. Evaluate for signs/symptoms and refer to endocrinology. May continue if adequately treated & monitored.

Serum plasma concentrations

X

X

X

X

X

0.8-1.2 (lower in elderly). Toxicity possible at lower serum concentrations. Monitor for clinical symptoms of toxicity.

Weight/body mass index (BMI)/waist circumference

X

Possible mechanism due to polydipsia, carbohydrate & lipid metabolism, glucose tolerance. Diet, exercise & low-calorie liquids.

Adapted from Gelenberg AJ. Laboratory and other testing for patients taking psychotropic medications. Biological Therapies in Psychiatry. 2004;27(11):41-44.

Pregnancy test

X

X

In women of childbearing age.

Neural tube defects 1%-2% first trimester.

Complete blood count with platelets and differential

X

X

X

X

Clinically significant thrombocytopenia rare.

Blood chemistries

X

X

X

X

At high doses, mild to moderate hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH. Reversible when lower dose)

Serum plasma concentrations

X

X

X

50-125 mcg/ml trough levels.

Prothrombin time

X

X

X

Monitor liver function.

Weight/BMI/waist circumference

X

X

Common. Not dose dependent.

Amylase

X

Rare cases of pancreatitis. Most commonly first 6 months.

Liver function

X

X

Liver function tests optional. Discontinue if >2.5 times normal AST/ALT. Plasma NH3 often increased transiently and may not necessarily mandate interruption of treatment.

Serum androgen assays

X

Symptoms of polycystic ovarian syndrome include obesity, hirsutism, amenorrhea.

Adapted from Gelenberg AJ. Laboratory and other testing for patients taking psychotropic medications. Biological Therapies in Psychiatry. 2004;27(11):41-44.