by Timothy Gieseke, MD, CMD

I recently had a patient with bipolar disorder who developed lithium toxicity (level 2.0) which likely had been present for several weeks prior to diagnosis.  Simultaneously, she developed hypercalcemia of 12.0.  Was the latter problem related to lithium toxicity or was there a new diagnosis to be sought?  Fortunately, I have personally subscribed to UpToDate, an evidenced based electronic library that updates on a regular basis most of the areas of clinical medicine.  

I was introduced to this tool many years ago at a local hospital where it was freely available on their computers.  I found I could quickly drill down to find information needed to more precisely address my patient’s specific clinical problem.  In this case, within 2 minutes on my smart phone app, I discovered lithium at higher levels is a known cause of hypercalcemia via its ability to increase calcium retention by the kidneys as well as its ability to stimulate PTH release from the parathyroid glands.  This meant I didn’t have to order expensive tests looking for a cause of the hypercalcemia and could instead focus on the immediate problem of optimally managing  both problems knowing that the hypercalcemia would resolve, once the lithium toxicity resolved.

In my community, all the acute hospitals have robust electronic medical libraries on their facility desktops available not only to the medical staff, but also to the rest of their team (licensed nurses, pharmacists, MSWs, Rehab team, etc.).  However, I have never seen the option for an electronic library in a SNF.  This is the reason I pay privately for UpToDate.

As we move towards lifelong learning, just in-time problem solving, and precision medicine, facilities will need to figure out how to build electronic libraries for their staff.  In my area, I’m hopeful that partnerships with local hospitals might include some form of library access.  Alternatively, leadership of SNF chains may find parts of an electronic library are cost possible, when spread across all facilities in the chain.

Here’s to a better future for our patients and staff.