Serum Concentration and Clinical Supervision in Monitoring of Lithium Treatment

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Abstract
Lithium (LI) therapy has become generally accepted as 1 of the major regimens for the treatment of acute mania, and for the prevention of relapse in recurrent bipolar mood disorders. It is 1 drug for which monitoring is understood to be crucial. The drug has broad interindividual variability in dose-response, often has a very narrow intraindividual therapeutic concentration index, has a broad interindividual distribution of sensitivity and tolerance, and is extremely dependent on stable kidney function for its successful and safe use. Determination of serum Li concentration is the most important monitoring technique. The need for standardized clinical procedure coupled with corresponding reference ranges remains to be satisfied. The 12 h standardized serum Li is seen as the answer to this need; the specifics of, and indications for, the procedure, in addition to the appropriate reference values for it, are given. The therapeutic range lies between 0.30 -1.30 mmol/l, with 1.50 mmol/l representing the lower limit of risk for intoxication. The treatment of initial and intercurrent Li intoxication, which can reach life-threatening proportions, is described.

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