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Situation:

  • A middle aged patient with no health insurance and a well documented history of moderate to severe bipolar disorder visits a low cost clinic.

  • The patient has a just lapsed lithium prescription and cannot get a refill directly at a pharmacy. The patient needs a new prescription for lithium, and this is the reason for the visit.

  • The health care provider would like to draw blood to test renal function.

  • Unfortunately, lab tests are not provided free, and the cost of the blood test is outside of the reach of the patient. A urine test is also too expensive.

  • There is more than one patient with this situation.

Question:

Is there an alternative method(without lab tests) that can assess whether the prescription can be safely filled?

Assume there is one doctor/physician assistant/nurse practitioner donating time.

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Blood tests to determine lithium levels are the gold standard for assessing the efficacy of lithium therapy. That said, a patient on a stable dose with no major adverse reactions is presumably within their body's therapeutic range. If there is preexisting renal dysfunction, that brings in a whole new can of worms. The signs and symptoms of lithium overdose are well documented and easily researched. I see many similar scenarios with metformin. Renal function should always to tested periodically throughout treatment but is rarely performed. I say that to say this, if the patient is tolerating the medication, isn't showing signs of renal dysfunction, and has no major reactions, I think it should be OK to prescribe/dispense the medication while diligently monitoring the patient for and changes.

  • Since health is an important topic, the site has a strict policy that all answers should be backed up with reliable references in order to provide the community with the means to assess the merit of the answer, regardless of the reader's background. See this list of reliable sources. If you still have trouble with this, feel free to visit the help center. – Narusan Jun 8 '17 at 21:29
  • Hmm I have gathered that by the time you start experiencing major side effects it is to quite late in your kidney failing. – William Jul 30 '18 at 19:43

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