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Difficulty: MediumMonitoring and Treatment Evaluation

A 42-year-old woman with a history of bipolar I disorder is admitted to the inpatient psychiatric unit with an acute manic episode. She has previously been nonadherent to medications but now agrees to initiate treatment with lithium carbonate. She has no other medical conditions and takes no other medications. Her physical examination is unremarkable. In addition to monitoring serum drug concentrations, which of the following laboratory parameters are necessary to evaluate at baseline and periodically during long-term maintenance therapy with this medication? (Select all that apply)

  1. Thyroid-stimulating hormone (TSH)Answer
  2. Serum calciumAnswer
  3. Serum creatinineAnswer
  4. D
    Liver aminotransferases
  5. E
    Complete blood count with differential

Answer

The correct parameters to monitor are thyroid-stimulating hormone (TSH), serum calcium, and serum creatinine.
Lithium is a mood stabilizer with well-known long-term toxicities affecting the kidneys (nephrogenic diabetes insipidus, chronic tubulointerstitial nephropathy), the thyroid gland (hypothyroidism, goiter), and the parathyroid glands (hyperparathyroidism). Therefore, standard of care dictates that baseline and periodic monitoring include serum creatinine, thyroid-stimulating hormone (TSH), and serum calcium. This ensures early detection and management of these adverse effects.

Step-by-Step Solution

1
Identify the initiated medication and its pharmacologic profile.
The patient is starting lithium carbonate for bipolar disorder.
Different mood stabilizers have distinct adverse effect profiles requiring specific monitoring strategies.
2
Determine the known long-term adverse effects of lithium.
Lithium is associated with thyroid dysfunction, renal impairment, and hyperparathyroidism.
Baseline and ongoing surveillance must target the organ systems susceptible to toxicity.
3
Select the corresponding laboratory tests.
TSH (thyroid), serum creatinine (kidneys), and serum calcium (parathyroid) are the necessary tests.
These tests detect the most common and clinically significant end-organ complications of lithium therapy.

Key Concept

Baseline and ongoing monitoring for lithium therapy must include renal function (creatinine), thyroid function (TSH), and serum calcium due to the long-term risks of chronic kidney disease, hypothyroidism, and hyperparathyroidism.
Estimated Time:1m 30s
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Topics

Monitoring and Treatment Evaluation

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