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Lithium Blood Test


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#1 cj2

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Posted 28 February 2006 - 06:35 PM

I am supposed to get a lithium blood level test tomorrow.  But I can't remember my doctor's instructions (it's either cognitive impairment or I'm just plain stupid).  How many hours after I take my last dose am I supposed to get the test?  12 to 14 hours? Or is it 10 to 12 hours?  And am I allowed the eat/drink before the test? Any help is gratefully appreciated.


#2 AirMarshall

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Posted 28 February 2006 - 06:38 PM

Take your Lithium.  Have the blood drawn 12 hours later. 

No restrictions on food or liquid intake just stay normally hydrated.


A.M.

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#3 cj2

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Posted 28 February 2006 - 10:02 PM

Thanks!

#4 synthetic

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Posted 28 February 2006 - 11:16 PM

No restrictions on food or liquid intake just stay normally hydrated.

<{POST_SNAPBACK}>


Unless you are having other tests done too.  I had my first one yesterday.  They stole seven vials of blood from me after I had been fasting for 12 hours.

Dx: BPsomething, General Anxiety, Social Anxiety
Rx: DepakoteER 1500mg, Seroquel 800mg, Topamax 100mg, Klonopin PRN, Lovastatin 60mg for high cholesterol caused by Seroquel
Meds that are evil: Lexapro, Prozac, Wellbutrin, Lamictal
Meds that didn't work: Lithium, Lorazepam, Geodon

#5 sepia

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Posted 01 March 2006 - 08:27 AM

Yeah.  I have to have a lithium level (no biggie) PLUS a crapload of other tests done tomorrow morning.  *sigh*
If I can stop one heart from breaking, I shall not live in vain. --Emily Dickinson

[link=http://xkcd.com/c150.html" target="_blank]we're all grown-ups here.[/link]

#6 EgoLost

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Posted 03 March 2006 - 04:54 PM

Uh-oh, I wasn't aware of this. I had my first test drawn at about 41/2 hours after taking my morning dose. Will this significantly change the results??
RX: Lithium 600mg, Effexor 150mg, Provigil 200mg, Seroquel 125mg

#7 AirMarshall

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Posted 03 March 2006 - 05:11 PM

Yes the test will show a high lithium level which is not accurate.  You need to call your doctor and tell them of this mixup. You need to repeat the test with the draw 12 hours after taking your lithium dose.

A.M.

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#8 peeej

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Posted 03 March 2006 - 06:38 PM

this is a big important piece of information.  would think drs, the blood lab people would know this. would think they would send me away and tell me to come back.

they ask what time i took the lithium. i had figured they calculate the level based on that amount of time, why else would they ask, write it down, and go ahead with drawing blood, if the results would then be inaccurate/unuseful?

i don't doubt this twelve hour thing, i just am agape slightly that it (seems) common practice to test the level 'whenever'. i was already getting antsy, bugging pdoc about my next levels, he said 'every six months' (one test on 300mg, then again on 600mg - but no second check on the accuracy of that) and now i discover the levels i've taken are probably not even accurate?? if they've been measuring them too high, then i probably don't have enough in my system? arg.

but if they're testing to get a good level at twelve hours, then .. um doesn't that increase the risk of toxicity? cause at four and a half hours it would be far higher, and possibly too risky for the liver etc etc.

i'm kind of confused. sorry. i'll be asking my dr. next appt. have to bug him for a req.
PJ AND BANANA!

#9 AirMarshall

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Posted 03 March 2006 - 07:52 PM

PJ,
The testing point for lithium is the "trough" or lowest blood level.   This probably assumes twice a day a day dosing, but even if you are using the newer slow release or XR versions it should still be valid.

My Pdoc reminds me of the 12 hour test point every time she orders it.   The blood techs however are quite sloppy and ask me about my last dose about one in four visits.   There is no place on the lab forms I have seen to record the time of patients last dosing.  I found 2 references quickly, I have others in books but I'm not going to bother retyping them   Here are a couple informative tidbits.  

A.M.

Lithium levels should be tested at least every 3-6 months and always after any significant dosage change.   This is because lithium dosage is not linear with blood levels; you cannot predict what the blood level will be when changing the dose.

Because the blood level of lithium rises rapidly for a few hours after swallowing a lithium pill and then slowly levels off, having a blood test right after taking the drug can mislead the doctor into thinking that the dose is too high. To gauge the average blood level accurately, it is important to have blood drawn about 12 hours after the last dose of lithium. Otherwise, the results will be misleading and possibly dangerous. Most patients take their nighttime dose of lithium and then come to the doctor's office the next morning to have a blood test before taking their first dose for the day. Some patients are able to take their full daily dose at bedtime and don't have to worry about the morning dose when getting a blood level.

http://www.bipolarbr...om/lithium.html



This is the lab index notes for technicians with Labcorp, a major US testing firm, and the one my insurance uses.

Collect trough level (just prior to next dose); at least six to 12 hours after the last dose.  Lithium is completely absorbed six to eight hours after oral administration. The plasma half-life is 17-36 hours, and this drug is eliminated almost entirely by the kidneys.

http://www.labcorp.c...00.htm#td012800


Edited by AirMarshall, 03 March 2006 - 07:54 PM.

**My work is done.  Swimming for the nearest shore.**


#10 ncc1701

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Posted 04 March 2006 - 12:14 AM

Heya cj2, PJ, et al,

No idea how I missed your posts, sorry!

We docs are supposed to tell you twelve hours after your last dose.  No excuses for docs omitting that.

Lab techs vary also.

Trough levels are the routine for *most* therapeutic drug monitoring, b/c of the need to assess steady-state blood levels (as A.M. mentioned).  Also b/c that's how the standard levels have been determined, so that's what we're comparing.

At least, that's what a hematologist told me once.  FWIW.

And if there's any concern re. toxicity, symptoms or whatever, we'll get a level right away and base treatment on *that.*

And there's usually a space for your doctor to write in; here it's a small box labeled "Additional clinical information."  I use it to write in the drug dosage and timing, and any other docs I want the results copied to.

Computerized order entry systems demand a time of last dose.

Some docs are idiots.  Or tired or cranky or distracted.  Or all four.

Sorry about that.

:embarassed:

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