Lithium Toxicity Part Two

I posted part one of this a few weeks ago and have never returned to it, mainly because I've had my mind on happier things. However, I suspect another chapter in this story is going to come before I finish this one, so it's time to move.

When we left off I had just been informed I had toxicity and that my thyroid wasn't working properly. I was to lower my dose and have blood drawn again in several days. I made an appointment with my family doctor to check on the thyroid for the next day. And then I had a fairly good day. I even felt like eating some, and rejoiced in that.

I was not sleeping at that point, so at 1 am I was working on a continuing education course. I suddenly felt extremely sick. I started doing everything that had ever worked to control the nausea, but nothing helped. Soon after I completed my course (and passed, one might note), I was vomiting profusely and in a way that was different than the worst illness I have ever had.

After about 2 hours I was vomiting so hard I was peeing my pants and not caring. At that point I realized I was very dangerously ill, especially because I couldn't get any fluids in to replace what I was losing, which would just make the levels stay high. I was fairly sure I needed to be somewhere there were IVs, but I couldn't get there. The nearest hospital that is capable of running an immediate lithium level is in the city my mother lives in, 30 minutes away and in the opposite direction of my psychiatrist. It didn't seem helpful to call my mother, wake her, scare her, have her come take me back down to her hospital, and then risk being where my own doctor couldn't help me if I could manage a few more hours.

Somehow I managed to develop a plan. I called my psychiatrist and left a calm message that I was very ill, needed feedback, would see my family doctor in the morning and if she wanted him to do anything to please call him, etc. I did not even think of paging her (after all, it was the middle of the night), which I suppose would have been a little more rational but truthfully, she couldn't have helped. I started sipping a very specific amount of water each hour and increasing it by a few tiny sips if that stayed down. Controlling that water intake was incredibly hard as I was very, very thirsty, but it took 3 hours of tiny sips before the sips stayed down.

After about 4 hours of vomiting and sobbing in terror on the bathroom floor I realized I was sicker than I had been admitting to myself and so I left my psychiatrist another message. This time I think I let my panic show more. I also left a message at my family doctor's asking to move my appointment up.

A couple hours after the vomiting stopped the doctor's office called and said to come immediately. I threw on clothes and drove in. He determined I had managed to control the dehydration well enough to avoid an IV (I believe this was a "for now" but am not sure), took a lot more blood and some urine, gave me medication for the nausea, and told me to stay on pedialyte for 24 hours. I remember him telling me that the nausea medicine would make me very sleepy and that I would need to wake up to sip fluids. I also was told to not do more than sip, even though I would want to. That urge only got worse, and the first popsicle I found was the best food I have ever tasted, even though I only ate part of it.

The psychiatrist called and gave me a lithium break and a new schedule to resume it.

Over the next few days I started to feel better, and eventually was able to increase my lithium. Very quickly it was clear that it took less to have a level close to the old one, which was higher than I could now safely take because it was too close to the toxic line (1.3 can be toxic, my old levels were 1.1-1.2. My highest measured level was 1.9 or 2.0. I've heard of levels over 4 but that is ICU and dialysis territory).

As the summer progressed I learned that I was more sensitive to heat. Always before if I got hot I could feel the side effects, but now I plain was sick. I was worried about this affecting my ability to work so we lowered the dose again. I did well on this dose, but eventually needed to try to increase it because my mood wasn't doing well.

That didn't work well (see Oct. 30 post, sorry I don't know how to link) and I recognized the early warnings very quickly and the dose was immediately lowered. At least I have now learned the specific bad feelings to watch for. That worked until the last week when things seem to be not going so well again. I'm waiting to follow up with the doctor to say more.

So, coming soon: Lithium Toxicity Part Three: Another Statistic, or Just Me Conquers a Pill?