Lithium in blood

Determination of Gold, Cobalt, and Lithium in Blood Plasma Using the Mini-Massmann Carbon Rod Atomizer". Anal. Chem. (1974), 1445-1449. 

Li+ Trioctylphosphine oxide + neutral carrier Lithium in blood serum and pharmaceuticals 136... 

E. X. Vrouwe, R. Luttge, W. Olthuis and A. van den Berg, Microchip analysis of lithium in blood using moving boundary electrophoresis and zone electrophoresis, Electrophoresis, 26 (2005) 3032-3042. 

Microfluidic devices have gained importance and utility for analyses of various molecules, including drugs and their metabolites. Vrouwe et al. [151] developed NCE for point-of-care testing of lithium in blood samples. The device consisted of a glass chip coupled with a conductivity detector. The authors tested this system for lithium analysis in five patients in the hospital. Furthermore, the authors reported that sodium, lithium, magnesium, and calcium were separated in <20 seconds. The authors claimed that the NCE system provided a convenient and rapid method for point-of-care testing of electrolytes in serum and whole blood. 

The analysis of clinical samples represents a typical application of flame photometry. Concentrations of sodium, potassium, and lithium in blood and urine are well within instrument working ranges. The specificity of the technique is a distinct advantage. Automated models of flame photometers, available during the past 25 years, are typically designed to serve the needs of the clinical chemist. Instrument calibration protocols are built into instruments to facilitate the timely analysis of sodium, potassium, and lithium in clinical samples. 

The next lesson is that an outlier is not necessarily the wrong answer, just one that is significantly different from the rest. Take as an example an international study of lithium in blood serum. Six laboratories took part and analyzed two samples having the same concentration of lithium (0.019mM). Figure 3.5 shows that laboratory 4 appears to have quite different results from the other... 

Lithium in blood was determined by Kimura et al.[4 ] by FI liquid-liquid extraction with proton-dissociable chromogenic 14-crown-4 derivatives as the extraction-spectrophotometric reagent. Lithium may be determined selectively in blood under a high sodium background of 130-160 mM, after extraction of the lithium complex into chloroform. The method also features a low sample consumption of 20 pi and high sample throughput of 100 h ... 

A 14-crown-4 derivative has also been incorporated in a PVC membrane to construct a coated-wire lithium ion-selective electrode used for the determination of lithium in blood sera, after on-line dialysis separation in a FIA system [6]. An estimation of the overall selectivity of the method over the sodium content, including that of the dialysis membrane and the electrode, resulted in a selectivity coefficient k of 1/50. This selectivity is not sufficient to overcome interferences from relatively large fluctuations in sodium contents, and corrections based on a simultaneous evaluation of the sodium content are required under such circumstances. 

Ion-selective electrode (ISE) systems are now available which allow the analysis of lithium in blood plasma in the presence of blood cells. The electrode measures the activity in solution of lithium ion and thus the electrical effects of the relatively large blood cells suspended in the plasma are negligible. The technology of the lithium ISE has been discussed [85]. 

Ion-selective electrodes are available for the electro analysis of most small anions, eg, haUdes, sulfide, carbonate, nitrate, etc, and cations, eg, lithium, sodium, potassium, hydrogen, magnesium, calcium, etc, but having varying degrees of selectivity. The most successful uses of these electrodes involve process monitoring, eg, for pH, where precision beyond the unstable reference electrode s abiUty to deUver is not generally required, and for clinical apphcations, eg, sodium, potassium, chloride, and carbonate in blood, urine, and semm. 

Clinical chemistry, particularly the determination of the biologically relevant electrolytes in physiological fluids, remains the key area of ISEs application [15], as billions of routine measurements with ISEs are performed each year all over the world [16], The concentration ranges for the most important physiological ions detectable in blood fluids with polymeric ISEs are shown in Table 4.1. Sensors for pH and for ionized calcium, potassium and sodium are approved by the International Federation of Clinical Chemistry (IFCC) and implemented into commercially available clinical analyzers [17], Moreover, magnesium, lithium, and chloride ions are also widely detected by corresponding ISEs in blood liquids, urine, hemodialysis solutions, and elsewhere. Sensors for the determination of physiologically relevant polyions (heparin and protamine), dissolved carbon dioxide, phosphates, and other blood analytes, intensively studied over the years, are on their way to replace less reliable and/or awkward analytical procedures for blood analysis (see below). 

Detection of Li+ in artificial serum with a voltammetric Li-selective electrode in a flowthrough system was demonstrated [64], Lithium salts such as lithium carbonate have been extensively used for treatment of manic depressive and hyperthyroidism disorders. The therapeutic range of Li concentration is generally accepted to be 0.5-1.5mM in blood serum. The authors used normal pulse voltammetry in which a stripping potential was applied between pulses in order to renew the membrane surface and expel all of the extracted ions from the membrane, similar to galvanostatically controlled potentiometric sensors described above. Unfortunately, the insufficient selectivity... 

Lithium salts, generally in the form of the carbonate or bicarbonate, are rapidly absorbed from the gastrointestinal tract and reach a peak plasma concentration after 2- hours. Extreme fluctuations in blood lithium levels, which are associated with side effects such as nausea, diarrhoea and abdominal cramp, are reduced by using sustained release preparations. Lithium is not protein bound and therefore is widely distributed throughout the body water, which accounts for the adverse effects it has on most organ systems should it reach toxic levels. To avoid toxicity, and ensure optimal... 

The clinical value of monitoring drug therapy by measuring plasma levels is probably best exemplified by reference to lithium (F6). It is a useful drug, which has a narrow therapeutic index, and treatment without reference to plasma levels is probably not ethically justified. Toxic side effects are predictable and severe. It has an acceptably long plasma half-life, and its measurement both in blood and urine is comparatively simple. Moreover, there is no problem of interference from either active or inactive metabolites. 

Menaker There is a similar effect in rodents. You can get effects on mice and rats with lithium in the drinking water, but you cannot get effects in hamsters. The reason for this is that because hamsters are desert animals they have an incredibly powerful kidney, and they simply don t allow the hthium concentration in the blood to rise to a level where it will do anything. 

Meltzer HY, Arora RC, Goodnick P Effect of lithium carbonate on serotonin uptake in blood platelets of patients with affective disorders. J Affect Disord 5 215-221, 1983... 

Some lithium salts such as H2CO3 are used to treat manic-depressive illness and hyperthyroidism. The manic-depressive therapeutic Li+ concentration range in blood is 0.75-1.25 mM, and it is known that more than 1.5 mM Li+ is toxic and that 3.5-4.5 mM Li+ is lethal. Because of the toxicity of ex-... 

Vrouwe, E., Luttge, R., van den Berg, A., Measuring lithium in whole blood using capillary. Micro Total Analysis Systems Proceedings pTAS 2002 symposium, 6th Nara, Japan, Nov. 3-7, 2002, 178-180. 

In 12 healthy volunteers, there were no clinically significant alterations in blood concentrations of lithium or nefazodone and its metabolites when the drugs were co-... 

In 12 healthy volunteers, there were no clinically significant alterations in blood concentrations of lithium or nefazodone and its metabolites when the drugs were coadministered (587). The addition of lithium for 6 weeks to nefazodone in 14 treatment-resistant patients produced no serious adverse effects and no dropouts (588). Lithium augmentation of nefazodone in 13 treatment-resistant depressed patients was associated with a variety of annoying adverse effects, but none led to treatment withdrawal (589). 

Contamination of lithium heparin blood culture bottles with Pseudomonas fluorescens led to an outbreak of pseudobacteremia and the unnecessary treatment of a number of children with antibiotics. Lithium had no direct role in this misadventure (703). 

In blood samples from 32 subjects, TSH and free T4 concentrations were no different in collection tubes that contained a lithium heparin anticoagulant compared with dry tubes, but free T3 concentrations were significantly lower (704). 

The major interest for Li+ analysis arises from the prophylactic and therapeutic action of Li+ in various affective disorders. Since the therapeutic action of Li+ is limited by adverse side effects above 2.0-2.5 mM Li+, monitoring of this analyte is indispensable. Reagents and methods (including ISE) for achieving high lithium over sodium selectivity and their use in blood lithium measurement have been reviewed <1996JPB899>. Enhanced lithium... 

Distribution in Blood. Lithium is taken up by erythrocytes to a variable extent which appears to be partly genetically determined. 

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