Abstract

Abstract
Background: Lithium has been used in the fields of rheumatology and psychiatry since the
1800s and it is now generally considered to be a gold standard treatment for bipolar disorders.
However, lithium is known to have significant side effects and requires close serum level
monitoring to ensure levels remain within the therapeutic range to minimize the risk of
serious adverse effects or toxicity. This article reviews the monitoring of lithium and reports on
the implementation of a regional lithium register and database within Norfolk.
Methods: Recorded blood results from the Norfolk lithium database were extracted for
the first full year of operation across the region, 2005/6, and from the most recent full year
2011/12. The number of lithium monitoring tests, U&Es and thyroid function tests conducted
on all people registered on the database were compared between the two sample years.
Results: In 2005/6 there were a significant number of people not receiving the recommended
number of four or more serum lithium test per year (68.3%) and the majority of people had
two or three tests (62%). By 2011/12 this had noticeably increased with the majority of patients
having four or more tests per year (68.5%) and the number having only two or three tests
reducing dramatically (26.4%).
Conclusion: Improved rates of lithium testing and monitoring have been demonstrated since
the introduction of the Norfolk database helping to achieve national targets. Consequently, the
chances of adverse events from insufficient monitoring have been minimized.