Lithium

Centralized Core Laboratory : Chemistry

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Lithium
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

LI ACHM1

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.5 mL

Cause for Rejection:

Hemolysis, any anticoagulant

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Spectrophotometric/Endpoint

Special Instructions:

Indicate date, time, and amount of last dose. Collect samples for lithium determination at least 12 hours after the last dose. Separate from cells if analysis is not performed within 4 hours.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Therapeutic range: 0.5-1.2 mEq/L. Toxic: > 2.0 mEq/L. Critical Limit: >1.5 mEq/L.

CPT Code:

80178

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Lithium

Centralized Core Laboratory : Chemistry

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