Lithium monitoring

Leboulanger, B., et al. 2004. Reverse iontophoresis as a non-invasive tool for lithium monitoring and pharmacokinetic profiling. Pharm Res 21 (7) 1214. 

Leboulanger, B., J.M. Aubry, G. Gondolfi, R.H. Guy, and M.B. Delgado-Charro. 2004. Non-invasive lithium monitoring by reverse iontophoresis in vivo. Clin Chem 50 2091. 

Another interesting application motivated by medicine is the use of the three-spin effect to determine lithium concentration solely through 1H DNP measurements. In a proof of principle study by Zeghib et al., an increased concentration of 7LiOH in aqueous solution with trityl radicals resulted in a decreased H DNP enhancement at 6.8 mT due to a competing three-spin effect.96 This was proposed to allow lithium monitoring... 

Serum lithium concentrations increased in 18 patients taking lithium who started to take a COX-2 inhibitor (rofecoxib or celecoxib) (671). The authors stressed the need for lithium monitoring when COX-2 inhibitors are used concomitantly. 

Eagles JM, McCann I, MacLeod TN, Paterson N. Lithium monitoring before and after the distribution of clinical practice guidelines. Acta Psychiatr Scand 2000 101(5) 349-53. 

CARBONIC ANHYDRASE INHIBITORS ANTIDEPRESSANTS -LITHIUM L plasma concentrations of lithium, with risk of inadequate therapeutic effect t renal elimination of lithium Monitor clinically and by measuring blood lithium levels to ensure adequate therapeutic efficacy... 

LITHIUM ANALGESICS-NSAIDs NSAIDs may t lithium levels cases of toxicity have been reported Uncertain NSAIDs possibly 1 renal clearance of lithium Monitor lithium levels closely... 

The concentration of lithium in serum, plasma, urine, or other body fluids has been determined by flame emission photometry, atomic absorption spectrometry, or electro-chemically using an ion-selective electrode. Serum analysis, the most useful specimen for lithium monitoring, is most commonly quantified by automated spectrophotometric assay. 

Phillips JD, King JR, Myers DH and Birch NJ (1989) Lithium monitoring dose to the patient. Lancet 11 1461. 

Seinivasan DP and Biech NJ (1996) Instant lithium monitoring a clinical revolution in the making. 

Paradoxieally, lithium toxieity oeeurred in another patient after a month of treatment with aeetazolamide. Lithium levels rose from 0.8 to 5 mmol/L, although it should be noted that the later measurement was taken 8 hours post-dose. See Lithium , (p. 1111) for details of lithium monitoring. 

In a further case a man taking phenytoin became ataxic within 3 days of starting to take lithium. He had no other toxic symptoms and his serum-lithium level was 2 mmol/L. However, as he only ever took lithium in the presence of phenytoin, it is not possible to say whether the effects were as a result of an interaction, or whether toxic levels would have occurred with the lithium alone. Another similar case has also been reported. Information seems to be limited to these reports and none of them presents a clear picture of the role of phenytoin in the reactions described. The interaction is not well established. Patients taking lithium should be aware of the symptoms of lithium toxicity and told to report them immediately should they occur. This should be reinforced when they are given phenytoin. Increased serum lithium monitoring does not appear to be of value in this situation as the interaction occurred in patients with lithium levels within the normally accepted range. 

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