Lithium and Toxicity

So, when I was diagnosed I was given a list of treatment options, Lithium being one of them - apparently the most successful at treating Bipolar Disorder - so this is what I chose.  Lithium treatment is a gruelling process and isn't for the faint-hearted.  It is a life-changing treatment option in more ways that one.

Prior to starting Lithium, I had blood tests done to ensure my thyroid and kidney function was okay, as this medication can impact upon these things. Once these blood tests came back I was started on 200mg, with weekly blood tests to check the Lithium level in my blood.  Lithium is a drug which has a very narrow therapeutic index - which means that the "space" between the dose that is right for proper effect and the dose that is toxic is very small.  Each week my blood tests came back and I was increased by 200mg until I got to 800mg mid-December.  My blood tests showed that the Lithium level was good and as I hadn't felt much change, Quetiapine had been added to my bedtime medication to help me sleep and act as a mood stabiliser.  Anyway, back to Lithium - I'm a girl who hated water - in fact, the only time I drank water was when it was boiled with coffee, sugar and milk.  But it is incredibly important to keep hydrated when taking Lithium because dehydration can cause the Lithium blood level to rise which in some cases can cause the drug to become toxic.  From the beginning, I was told this, the symptoms of toxicity, reminded that if I wanted to have another child it would have to be discussed at length, that I can't take a number of over the counter medications and alcohol if any had to be minimal etc. etc.

On Sunday 30th January, I and my partner (Fra) came over to my mummy's house for dinner and as soon as I sat down I didn't feel right.  One minute I was sweating, the next I was shivering.  I sat and ate my dinner but felt my stomach churning with every bite.  After dinner, we all went into the living room and I knew I needed to be sick, this is when my leg started to shake uncontrollably. Eventually, I began to vomit - but it wasn't even like vomiting - it was just coming up, no wretching, gagging or effort.  I knew these were signs of toxicity.  I decided I would ring the Dr on call when me and Fra got home - the call back time was 3 hours and I knew I had to take my Quetiapine.  I had had 7 big episodes of vomiting over the space of around an hour and a half and wasn't keeping any fluids down.  I waited for the call back during which time I became tired and the vomiting had settled down so the Dr told me that if I hadn't passed urine 2 hours after waking in the morning to go straight to A&E. 

I got up on Monday morning and felt completely drained but I passed urine - with great difficulty.  We decided to see how I went through the day and then decide on what to do.  The further into the day we got the more I felt like I had the night before - hot and cold sweats, my leg moving uncontrollably and by 6 o'clock I had only passed urine twice.  This time when I rang the Dr on call I got an appointment and Fra took me in.  She checked my last Lithium level which had been done a few days ago which was 0.5 and had to consult with another Dr to check if it could go toxic that quickly - IT COULD, and so I was sent to A&E.  As soon as I went in I was put in a bed and my blood was taken and I was given IV fluids - the first bag of 4.  After the blood tests came back I was told my Lithium level had shot up to 1.0 from 0.5 which is the high side of normal.  All of this was caused by being dehydrated from a stomach bug. 

Mine and Fra's first New Year together was spent in A&E and while I was incredibly sick (physically for a change and not by my own doing) it was the best New Year I've ever had.  Around 6 in the morning I was moved up to the surgical ward and given more fluids and more blood taken.  All the time with Fra there - making me laugh, bringing me chocolate, letting me sleep, keeping my spirits up and helping me wheel my drip down to get a smoke, and also taking highly attractive pictures of me while I slept and as I walked through the halls with my unicorn dressing gown trying not to crash (lol).

Thankfully after one more night, I was able to go home.  Now knowing if I ever have a stomach bug I have to go straight to the Doctor.

After all of this, my biggest fear was that they would stop my Lithium because it's the treatment I chose and the treatment I wanted to pursue in my road to recovery.  Thankfully they didn't and experiencing mild-moderate toxicity has opened my eyes to the importance of keeping hydrated.  Lithium treatment can take a year to see the full benefits, it is a long term commitment and something that should be considered carefully if it is the treatment that you may decide upon.  I know I never thought that a stomach bug would have impacted upon my treatment the way that it did.  Any form of dehydration be it from caffeine, exercise, sunbeds, alcohol, vomiting - needs to be considered whilst taking this medication.