Biochemical Monitoring of Patients on Lithium – a Year-long Nation-wide Audit

Authors: Dr. Christopher Rolé, Dr. Gabriel J. Ellul

Aims and Hypothesis: To perform a nation-wide audit on whether all patients on maintenance lithium treatment throughout the year 2017 were biochemically monitored according to Maudsley Guidelines.

Background: Lithium is an effective mood-stabiliser with evidence-based antisuicidal properties, whose use is licensed for the acute treatment of mania and maintenance treatment of patients diagnosed with bipolar affective disorder. Given its well-known narrow therapeutic index, there is risk that patients on lithium receive improper dosing which may lead to treatment ineffectiveness or toxicity. UK Maudsley Guidelines therefore advise that patients on maintenance lithium treatment should have biochemical monitoring of their serum lithium level, along with renal and thyroid functions at least every six months.

Methods: Records of all patients regularly collecting their prescribed dose of lithium from government pharmacies were obtained from the national register. Patients who collected lithium regularly from the year 2016 up until 2018 were identified and studied as the population of choice, with the inference that they were on maintenance lithium treatment throughout the year 2017. Biochemical data of the selected patient cohort was accessed from the national electronic database and data from each patient was stratified according to conformity with suggested guidelines.

Results: 609 patients were identified as receiving maintenance lithium treatment throughout the year 2017. Of these patients, 110 individuals (18.06%) were biochemically monitored according to Maudsley Guidelines. The remaining 499 patients (89.94%) did not meet the suggested criteria for biochemical monitoring while receiving maintenance lithium treatment.

Conclusions: On a nation-wide scale, throughout the year 2017, less than two out of every ten patients regularly receiving maintenance lithium treatment were being optimally monitored according to guidelines. This highlights the need for more rigorous biochemical monitoring of these patients. The introduction of a lithium clinic, aimed at biochemical and medical monitoring of this patient cohort, may thus prove beneficial and warrants further discussion.

No financial interests declared