Lithium toxicity

[Canucklehead]

So last week I tested as lithium toxic, and something kidney-related but not bad enough for any sort of treatment. My pdoc pulled up my labs on the computer and the lab didn't flag it, because my level was 1.5 and apparently they start flagging at just above 1.5. But my pdoc considered 1.5 a toxic level and was worried about the kidney stuff, so she sent me directly to the emergency room.

 

The ER wasn't too worried because I didn't have any symptoms of lithium toxicity. Both my pdoc and the ER doc expected something, nausea, GI problems, tremor... but I didn't have any. I basically sat in a chair for 5 hours. Eventually they took my blood again to confirm that it wasn't a mistake, and then they put me on an IV. I sat there with an IV for 40 minutes, and then my level came back as 1.2 so they sent me home. I was so glad to get out of there.

 

My pdoc was annoyed though because she had asked the ER to do an EKG and a urine test, and they didn't do it. She was also concerned because they took the blood for the 1.2 blood level close to the time where I would have taken my lithium, and apparently my level shouldn't be that high just BEFORE I take my nightly lithium.

 

My pdoc is monitoring me closely for a while, blood test next Wednesday and then every two weeks. The lithium's not really helping, so if I continue to test toxic we're going to nix it and try depakote.

 

The thing is, I feel like it would be very possible for me to continue to be toxic. I skipped a dose of lithium the night I was at the ER, and since then my dose has been reduced by 300 mg. I *know* I tend to get anxious and think my way into symptoms, but I am having some of the usual lithium toxicity symptoms, like nausea, GI disturbances, joint pain. But just mild, not severe at all. I'm also constantly sore and tired. In the past I could stay up late no problem, now I start feeling like going to bed at 10.

 

But why am I having symptoms now? Is it possible I had them last week when I was toxic but didn't pay attention to them, and now that I'm looking for it, I catch it when it happens?

Edited March 31, 2014 by Canucklehead

[tamagotchi]

As the dose decreases, your blood level will decrease and symptoms should lessen.  They lower the dose gradually because if you go off lithium very quickly it can cause mania.  Yes, it's possible that you may be noticing symptoms more now, because you are thinking about them more.  Since your symptoms aren't severe, and your pdoc is watching you closely, I think you shouldn't worry.  I became toxic and had scary symptoms (confusion, slurred speech, etc), then as the dose was lowered, I got better but it didn't all happen instantly.

 

A level of 1.5 is high but not necessarily toxic for everyone.  People are different in the blood level they can tolerate without being toxic.  Some become toxic at low levels <1.0 and others can tolerate higher levels >1.5.  So don't let the number freak you out by itself.

Edited March 31, 2014 by tamagotchi

[Canucklehead]

They've been taking me off the Lithium and my levels have dropped to 0.5 but the symptoms are getting worse, not better. At first I seemed to be peeing a lot more. It got worse until now I'm always thirsty, am peeing every 1-2 hours, and the urine is so diluted that it has no colour at all. Even if I don't increase my fluid intake this happens, so I've increased my fluid intake anyway to try and keep from getting dehydrated. My pdoc obviously can't diagnose this so she's referring me to a nephrologist. The test results came back that my kidneys are not concentrating my urine. I have to do a 24 hour urine test this weekend which means I have to stay home for 24 hours and collect all of my urine. I'm not sure what that test is supposed to show. And I will hopefully get to see the nephrologist within 2 months. And they'll probably do more tests.