Decreasing requirement for lithium carbonate therapy in bipolar affective disorder (hypomanic type) following the onset of chronic renal insufficiency

The importance of regular monitoring of both serum lithium and creatinine l evels, together with thyroid function assessment, in a patient taking lithi um carbonate therapy for bipolar affective disorder (hypomanic type) is emp hasised. In this case it was the gradual rise of serum creatinine that aler ted the physician to the onset of insidiously progressive rectal impairment . In the absence of any evidence for another aetiology, it was concluded th at a possible cause for the renal problem was the lithium therapy itself. B y reducing the dosage it was found that serum lithium levels were maintaine d within the reference range, thus avoiding the potential psychiatric conse quences of high concentrations - which could well have occurred had the for mer dosage been continued during the period of deteriorating renal function . The situation is currently being carefully monitored in case another caus e for renal disease, other than that of a side-effect of therapy, emerges a t a later date.