- 3700 critical and TDM alert reports over ten years; haematological drug concentration warnings comprised 49.7%.
- Common abnormalities: leukopenia, hypokalaemia, hyperglycaemia and elevated venlafaxine metabolites, indicating drug adverse effects, adherence issues and comorbidity.
- Recommend individualised critical and TDM alert thresholds by patient characteristics to improve management, optimise medication use and reduce adverse outcomes.
Ther Drug Monit. 2026 Oct 19. doi: 10.1097/FTD.0000000000001529. Online ahead of print.
ABSTRACT
BACKGROUND: Critical values in laboratory testing and alert values for therapeutic drug monitoring (TDM) are essential for clinical safety and psychotropic drug optimization, yet their distribution, associated factors, and clinical significance in psychiatric specialty hospitals remain insufficiently characterized. Therefore, we aimed to determine these parameters to provide a theoretical basis for optimizing critical value management and psychotropic drug use.
METHOD: A retrospective analysis was conducted on critical value reports from the clinical laboratory and TDM alert value data of inpatients and outpatients at the Affiliated Mental Health Center of Kunming Medical University from January 2016 to December 2025. The incidence of critical and TDM alert values, sex and age differences, project composition ratios, and distributions by ward and disease diagnoses were analyzed.
RESULTS: A total of 3700 reports of critical and TDM alert values were included with 27.27% older than 65 years (63.49% female and 36.51% male). Among the categories of hematological routine, biochemical, coagulation critical values, and hematological drug concentration monitoring warning values, hematological drug concentration monitoring warning values accounted for the highest proportion. (49.73%) and among individual test items, the top‑five items were: white blood cell count (15.89%), serum potassium (8.87%), myoglobin (7.06%), glucose (6.27%), and TDM venlafaxine and its metabolites (5.81%). The critical and TDM alert values came from the geriatric psychiatry (1220 cases; 32.97%), outpatient (803 cases; 21.70%), and sleep medicine (8.08%) departments.
CONCLUSIONS: In this psychiatric specialty hospital, Among the categories of hematological routine, biochemical, coagulation critical values, and hematological drug concentration monitoring warning values, hematological drug concentration monitoring warning values accounted for the highest proportion. The predominant individual issues included leukopenia, hypokalemia, hyperglycemia, and elevated venlafaxine metabolite levels, which may be associated with the adverse effects of psychotropic medications, patient adherence, and comorbid physical illnesses. Individualized critical and TDM alert value thresholds should be determined based on specific characteristics to provide healthcare professionals with reference criteria for assessing disease severity to improve the quality of critical value management and medication use and reducing the incidence of adverse outcomes.
PMID:42895342 | DOI:10.1097/FTD.0000000000001529
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