Q: My cousin suffers from Maniac Depressive Psychosis and has been on Licab (Lithium bicarbonate) 2 tablets of 300 mg twice every day for over 20 years. This has affected his kidneys. They are now 45% functional as per the ultrasound report, and he has been advised 40 gm protein, 4 gm salt diet. His BP ranges from 120/80 to 130/90 after taking Hopace 2.5 mg daily every morning. It was 140/100 before starting Hopace. Licab has been changed to Valproic Acid tablets, 300 mg morning and 500 mg at night. He cannot stick strictly to the diet and has to eat out entertaining clients, etc and takes beer (no whiskey or other hard drinks) twice a month. He is now taking the following medicines: 1. Hopace 2.5 mg daily morning 2. Shelcal 300 mg daily morning 3. Neutrisan 1 capsule daily morning 4. Valproic Acid tablet 300 mg every morning and 500 mg every night. 5. Ferrium Plus tablet daily morning Please tell me if this treatment and the diet is OK. How much longevity can he expect?

A:Out of 5 medicines, the therapeutic value of two i.e. ramipril 2.5 mg (sold under various brand names by Indian manufacturers such as Hopace; Cardace is the brand name of the original researcher, Aventis, and is available in India) and Valproic acid 300 mg in the morning and 500 mg at night is clinically justified. It is not clear as to why Neutrisan and Ferium are being given, that too concurrently. Neutrisan contains iron (in the form of ferrous fumarate 20 mg) while Ferium also contains iron (in the form of hydroxypolymaltose complex equivalent to 50 mg iron). Iron is given only when the patient is suffering from iron-deficiency anaemia. There is no history of iron-deficiency anaemia in the patient. Same is the situation with calcium supplements. Neutrisan and Shelcal both contain calcium. Unless a person is suffering from calcium deficiency as determined by blood calcium levels, unnecessary calcium supplements do not give any benefit. In fact sometimes they are harmful. The body requirement of calcium (approximately 0.6 to 0.8 g daily) is met by nutritional sources; there is no need to give calcium supplements. Since calcium is excreted by kidneys (100-400 mg/per day), it can be toxic to kidneys if they are overloaded or already impaired. Drinking beer twice a month poses no health risk in this case. Low protein, low salt diet is strongly recommended. Once lithium has been discontinued, there should be no further kidney impairment. In fact there is a chance that it will improve in due course. In any event the level of kidney function is adequate. Unless some other factors, such as blood pressure, diabetes, etc, adversely effect the kidney function in future, the patient can live a normal life.