Introduction: Lithium is a medication indicated for the treatment of bipolar disorder and in treatment resistant depression, with a narrow therapeutic index. Overdose, either acute or chronic can result in neurological symptoms, requiring dialysis and admission to intensive care in some cases. Lithium toxicity is avoidable with careful monitoring. However, we have noted several recent cases of lithium toxicity in our local service and thus sought to investigate this issue in a more systematic manner. Aim: We aimed to quantify the incidence of lithium toxicity in our local population over a single year and identify the patients most at risk. We also aimed to generate clinical recommendations on the prevention of lithium toxicity to improve patient safety. Method: We identified the incidence of lithium toxicity in our local population, by searching the hospital pathology database for patients with serum lithium levels greater than 1.0mmol/L. We examined the available clinical notes for these patients. Results: We identified 74 serum lithium readings above 1.0mmol/L measured in 44 individual patients. The highest recorded level was 3.2mmol/L. Of these, eleven patients were aged 65 years or older. Hospital admission was required in 14 cases. There was missing data of note: 29.5% had no renal function/eGFR measurement at time of toxicity and 52.3% without a baseline eGFR. Conclusion: Lithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over.

Background Human papillomavirus (HPV) is strongly linked to the pathogenesis of cervical dysplasia; women with IBD may be at greater risk of developing cervical pathology, especially those on immunosuppressive therapies. In Ireland a national screening programme begins at age 25 and continues until age 60. This was a preliminary study looking at the number of women seen at our IBD clinic with a prior abnormal smear test, and the correlation to their medication history. Methods All women attending our IBD service, over an 8 week duration, were asked to complete a questionnaire regarding previous smear testing and results. We also looked at their diagnosis, years since diagnosis and medication history. Any patient who was referred on for a colposcopy was considered as having an abnormal smear. Results A total of 80 women with an average age of 51.5 years (SD ±±33.5) and with an average 20.8 years (SD ±±20.2) since diagnosis had been screened. 10 were under the age of 25 and thus excluded, of these 7 were vaccinated against HPV. Seven women who were eligible, had never had a smear and therefore excluded. A total of 63 women previously had a smear test in their lifetime. Conclusion Conclusion Our study shows that women in our IBD cohort have a significantly higher risk of having an abnormal smear vs. the average Irish women (23.8% vs. national average of 9.8%, p = 0.006). Furthermore, the majority (80%, p < 0.001) of these patients were on immunosuppressive therapy at the time of the abnormal smear test. While the conclusion we can draw from this study are limited, we believe it emphasises the need for stringent adherence by IBD patients to screening guidelines for early detection of cervical dysplasia.