Lithium Toxicity or Poisoning
Dangers of Rx Drug Treatment for Bipolar Disorder
Apr 17, 2008 Christina Gleason
Lithium is a popular prescription mood stabilizer used in the treatment of Bipolar Disorder, also known in pop culture as Manic Depression, but it can have toxic effects at high levels in the blood stream.
The therapeutic benefits of lithium were realized long before the science was understood. Certain freshwater springs - like those found in Saratoga Springs, New York - were believed to have healing properties; high lithium content in the water did indeed appear to cure madness in the 18th and 19th centuries before psychology and pharmaceuticals became better understood.
But Bipolar patients who have been prescribed lithium need to be closely monitored by their entire treatment team (psychiatrist, therapist, primary care doctor, etc.) to watch for the signs of lithium toxicity. Lithium has a very narrow therapeutic window, a level of the drug in the body that is not too low to be ineffective but not too high to cause toxicity.
Unfortunately, in today's society where many patients have a number of different doctors and specialists, and may change doctors several times during the course of their treatment because of insurance coverage, moving, or personal reasons, it can be difficult for doctors to keep track of every patients presenting symptoms and symptoms that develop as a result of certain treatments.
Symptoms of Lithium Toxicity:
- Increasing diarrhea
- Vomiting
- Anorexia
- Muscle weakness
- Lethargy
- Giddiness
- Ataxia
- Poor coordination
- Tinnitus (ringing in the ears)
- Blurred vision
- Tremor of the extremities
- Tremor of the jaw
- Muscle hyperirritability
- Choreoathetoid movements (rapid and jerky involuntary movements)
- Dysarthia (poor speechy articulation)
- Drowsiness
- Nephrogenic diabetes insipidus
More severe symptoms of acute lithium toxicity can also include stupor, seizures, coma, and cardiac symptoms that could lead to heart failure in patients with underlying heart disease.
Because patients with Bipolar Disorder may have any number of co-morbid illnesses, it can be difficult to recognize when certain symptoms are due to lithium poisoning or something else. Many people have gastrointestinal conditions, like Irritable Bowel Syndrome, which may mask diarrhea and vomiting caused by high lithium levels, or may indeed be caused by lithium toxicity. The only way to determine whether or not lithium treatment is causing some of these symptoms is to discontinue lithium and wait to see if they disappear or lessen in severity.
Lab Tests for Lithium Toxicity
In order to prevent lithium toxicity, there are a number of tests that can be ordered for Bipolar patients who have been prescribed lithium.
- Serum lithium level or plasma lithium level
- Electrocardiogram
- CT scan of the head
- BUN and creatinine measurements
Patients with Bipolar Disorder who are taking lithium may need to request some of these laboratory tests if they feel their doctors and treatment team have not identified potential lithium toxicity on their own. Because doctors see increasing numbers of patients and do not always have the time and energy to concentrate on every patient's complexities, it is very important for patients to advocate for themselves when they feel there is a problem that is not being addressed.
This article is not a substitute for medical advice. Please consult with your physician. For more information about lithium toxicity, visit Wrong Diagnosis or eMedicine.
Lithium can be toxic.
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