Audit standards in lithium therapy.
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Biomedical subjects
Publications and source records attributed to D P Srinivasan.
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Trace elements play an active role in various metabolic processes of the body. Current evidence suggests that a disturbance in the concentration of trace elements can produce various psychiatric symptomatology. The precise role of these micronutrients needs further elucidation in view of their potential importance in the field of treatment and prevention.
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1. Arginine vasopressin (AVP) was measured in morning samples of urine from 58 patients treated with lithium for unipolar or bipolar affective disorders and from 25 healthy control subjects. 2. The AVP excretion rate was increased in the patients treated with lithium and was related to the plasma lithium concentration. The increase in AVP excretion is the result of a renal resistance to AVP so that what has been observed is an effect of lithium in vivo related to its plasma level over the therapeutic range.
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The recent availability of portable ion selective electrodes (ISE) for clinical applications has enabled lithium estimations to be performed instantly and at close proximity to patients. The significance of this is, not in the accuracy of the determination, but in the speed of the feedback provided to doctor and patient, and hence the promotion of compliance. The impact of this on lithium therapy can only be described as a clinical revolution in the making.