Lithium Toxicity (Part One)

Please Note: There's another new post after this one. I thought I was setting this to post with a delay but I was wrong.

I spent half of this year with undiagnosed lithium toxicity. I honestly thought that was something that would never happen to me. I'd been taking it for years, was well educated on all the things to avoid and all the things to do. I did everything right, even exceeding my daily water requirement every day. Yet when it hit it did so in a way that nobody saw it until it was severe. After it was diagnosed I started looking for information and discovered little was available, and most of what was available frightened me. This is my more hopeful story of recovery from lithium toxicity. Regular readers may find this somewhat repititious (if you were able to sort this out as it went, I don't think there were specific posts because I was too confused at that time to write them), but I'm hoping this one may reach someone else who is desperately searching for that search term.

I was very unlucky in how the whole thing presented. I had had frequent vomiting episodes off and on for years, attributed to difficulty taking pills after lamictal was a bad experience. (It had a bad taste and I just learned to throw up if I tasted it). My lithium level was always high but stable and never dangerous.

In January I was due for my 6 month labs. I got the slip from the doctor and before I could have them drawn I had stomach flu. That meant I had to wait 5 days to get a stable level again. The problem was that I had taken on some additional work and just did not have time to get a level done. Because the level has to be done 12 hours after the pill is taken and my lab is a long way from my old work, sequencing the thing is very difficult. Since I'd always been ok I didn't think much about putting it off.

By the end of January I was under huge amounts of stress. My therapist was leaving the country permanently in a month. I'd had a euphoric manic period for a week which always throws me way off kilter. I was so upset about the therapist that I wasn't eating. That seemed a reasonable explanation for the nausea. Without being able to eat I couldn't take my meds, so they just went by the wayside. We all thought when the therapist transition was over I would eat again and get back on meds. I even arranged a very long vacation to allow time for this; the entire vacation was centered on adjusting to the new therapist and getting on full and consistent doses of meds.

After one week of meds I felt terrible again and stopped eating. I went to my family doctor who thought my gallbladder might need removed. I had an ultrasound, and the day of the ultrasound was the first time I really acted lithium toxic, except I did not know it. I was told not to drink or eat anything after midnight but to take my pills. The test was scheduled for 11 and wasn't done until after noon. That is an extremely long time to not have water with my lithium dose. Now I know better. So I spent the morning sort of confused. For example, I had backed out of my driveway when I realized I was wearing slippers, not shoes. I kept getting lost at the hospital. I backed into something. I felt vaguely confused. And oh, the nausea...so bad.

When the gallbladder test was negative I was just treated for nausea for a while and given ulcer medication. When that didn't work I went on super-ulcer medicine. By that point the doctor was pretty sure I had 3 distinct little ulcers because he could always poke precisely the same places and get pain. I really didn't want to have a scope done to verify because I knew from experience I'd have trouble with the sedation.

And so I went on, losing weight, vomiting, and not eating. I lived on water for about 2 months. I lost a total of 30 lbs. from not being able to eat.

During that time work was awful (refer to March 2006). It still seemed reasonable to attribute my illness to stress, at least to me. Others were beginning to wonder but I wasn't listening. My logic was deteriorating quickly. Yet that seemed to make sense as I was not taking meds. Every time I tried, and I did try repeatedly, I just threw up more than I already was.

Ultimately I wound up on disability. I truly thought I could get some rest, get back on meds, and be back to work in 2 weeks. Nobody even tried to argue. I was really upset and shocked when 3 weeks later all I knew was that I was worse, not better. But I was holding the meds down. Lord only knows how, but I was. The goal was to get to full doses of both depakote and lithium for 5 days so I could get a level. I made it. While I was getting to that point I noticed the psychologist watching me walk and trip and looking concerned but not saying anything. By this point my speech was no longer fluent and I had to stop to remember about every 5th word. I sometimes cried because sentences wouldn't come out. The psychologist contacted the psychiatrist with his suspicion that I was toxic. I had no clue and in fact one thing I remember clearly was stating that I thought my level felt low.

The day after my labs I had gone to the greenhouse to pick up a mother's day gift. I had a message on my cell when I got back to the car. I was surprised that it was the psychiatrist and I believe she was equally surprised that I was well enough to be out doing errands. But her news that my level was quite high explained much.

And so a new chapter of my life began.......And to keep this post from being a book, you will have to see Part II for the next part of the story. In fact, there may even be a part III to keep it all divided up.