Adverse events have been observed in animal reproduction studies. Lithium crosses the placenta in concentrations similar to those in the maternal plasma (Newport 2005). Cardiac malformations in the infant, including Ebstein anomaly, are associated with use of lithium during the first trimester of pregnancy. Other adverse events including polyhydramnios, fetal/neonatal cardiac arrhythmias, hypoglycemia, diabetes insipidus, changes in thyroid function, premature delivery, floppy infant syndrome, or neonatal lithium toxicity are associated with lithium exposure when used later in pregnancy (ACOG 2008). The incidence of adverse events may be associated with higher maternal doses (Newport 2005).
Serum lithium concentrations in uncomplicated cases receiving maintenance therapy during remission should be monitored at least every two months. Patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations of to mEq/L. Geriatric patients often respond to reduced dosage, and may exhibit signs of toxicity at serum concentrations ordinarily tolerated by other patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Antinuclear Antibody Screen (ANA); Anti Strptolysin-O (ASO); Calcium (Ca); Chem 6 [Blood Urea Nitrogen (BUN); Creatinine; Electrolytes [ Carbon Dioxide (CO2); Chloride (CL); Potassium (K); Sodium (Na) ]; Complete Blood Count [ Automated Differential; Hematocrit (Hct); Hemoglobin (Hgb); Mean Corpuscular Hemoglobin (MCH); Mean Corpuscular Hemoglobin Concentration (MCHC); Mean Corpuscular Volume (MCV); Platelet (PLT); Red Blood Cell Count (RBC); Red Cell Distribution Width Standard Deviation (RDWSD); Red Cell Distribution Width Coefficient Variation (RDWCV); White Blood Cell Count (WBC)] ; C-Reactive Protein (CRP); Creatine Kinase (CK); Epstein-Barr Virus Basic Panel [Epstein-Barr Virus Antibody IgG; Epstein-Barr Virus Antibody IgM] ; Estrogen, Total; Glucose Random; HLA-B27 Antigen; Insulin - Like Growth Factor 1 (IGF-1 / Somatomedin C); Magnesium (Mg); Parathyroid Hormones Intact (PTH Intact); Progesterone; Protein Electrophoresis; Rheumatoid Factor (RF); Sedimentation Rate (ESR); Testosterone, Total; Thyroid Profile with TSH [Free Thyroxine Index (FTI); T3 Uptake; Thyroid Stimulated Hormone (TSH); Thyroxine Total (T4)]; Uric Acid