Warning about Lithium

[sbwertz]

If any of you are taking lithium, be aware that if you get dehydrated, it can build up in your bloodstream and be life threatening. My cousin is in the hospital with lithium poisoning, and they aren't sure if he will survive, and if he does whether he will have permanent brain damage. It was very hot in OK City this year, and he let himself get dehydrated. They didn't know what was the matter with him, and continued to give him the lithium. Now he is awake, but "not all there." (They had to take his phone away because he thought he was kidnapped and called 911.) There is no known treatment, other than palliative.

 

[TonyL]

Prayers sent.

 

[jttheclockman]

This is sad news and prayers go out to him for sure. Medications sometimes can do harm if not followed correctly and this is a good warning for everyone to take a closer look at all their medications and make sure you understand the side effects and things to do and not do when on them. We have no idea what lies in the future when vaccines come out for this deadly virus and we still have so much to learn about its long term effects. Hopefully the doctors can reverse the damage and he gets well again.

 

[magpens]

Sorry to hear about your cousin, Sharon.

Thanks for this warning ! . Gosh ! . We have to be so careful and mindful of so many things !!

 

[Bob in SF]

Sharon - Sorry to hear this.
Treatment/testing:
Rehydration
Avoidance of nonsteroidal anti-inflammatory medicines - Advil, Aleve, Tylenol
No alcohol
Drink an extra cup of coffee since caffeine drives down lithium levels
Adequate (table) salt intake because lithium is a salt that competes with NaCl (table salt) for absorbtion and secretion
Dialysis for severe cases
Check blood levels of hydroxy vitamin D, B6, B12 (lithium commonly causes D deficiency) - may need an endocrinology consult to sort this out
Check thyroid function tests: T3, T4, Free T4, TSH, TPO (lithium can cause hypothyroidism)
24 hour urine testing - lithium consumers can suffer nephrogenic diabetes insipidus (different from Type 2 diabetes) -
check for this with a 24 hour urine sample - a hypotonic urine supports this diagnosis, and is typically defined as a urine with an osmolality of <300 mOsm/Kg.
Check serum calcium because lithium toxicity (which is defined as 1.5 for moderate and 2.0 for severe toxicity) - because lithium toxicity frequently causes hypercalcemia - may also need to check parathormone (parathyroid function) - will need endocrinology consult if markedly abnormal
Take liquid CoQ10 200-300mg daily to support brain mitochondrial bioenergetics
Use CPAP if there is any sleep apnea beyond 5 apneic episodes per hour in order to maintain brain and body oxygenation during sleep
Hope some of this helps - Bob

 

[sbwertz]

He's in a long term care hospital right now, and they are doing their best for him.

 

[Bob in SF]

Understood - just a few suggestions (based on experience).

 

[wolf creek knives]

Sorry to hear about this Sharon. Just out of curiosity, why would one take Lithium?

 

[howsitwork]

depression

 

[Jim15]

Sorry to read this. He will be in my prayers.

 

[leehljp]

Lifting him and his family in prayer.

 

[pshrynk]

Sharon - Sorry to hear this.
Treatment/testing:
Rehydration
Avoidance of nonsteroidal anti-inflammatory medicines - Advil, Aleve, Tylenol
No alcohol
Drink an extra cup of coffee since caffeine drives down lithium levels
Adequate (table) salt intake because lithium is a salt that competes with NaCl (table salt) for absorbtion and secretion
Dialysis for severe cases
Check blood levels of hydroxy vitamin D, B6, B12 (lithium commonly causes D deficiency) - may need an endocrinology consult to sort this out
Check thyroid function tests: T3, T4, Free T4, TSH, TPO (lithium can cause hypothyroidism)
24 hour urine testing - lithium consumers can suffer nephrogenic diabetes insipidus (different from Type 2 diabetes) -
check for this with a 24 hour urine sample - a hypotonic urine supports this diagnosis, and is typically defined as a urine with an osmolality of <300 mOsm/Kg.
Check serum calcium because lithium toxicity (which is defined as 1.5 for moderate and 2.0 for severe toxicity) - because lithium toxicity frequently causes hypercalcemia - may also need to check parathormone (parathyroid function) - will need endocrinology consult if markedly abnormal
Take liquid CoQ10 200-300mg daily to support brain mitochondrial bioenergetics
Use CPAP if there is any sleep apnea beyond 5 apneic episodes per hour in order to maintain brain and body oxygenation during sleep
Hope some of this helps - Bob

What Bob said. Lithium is one of the more difficult medications for us to manage. Staying on top of the dosing and levels is absolutely essential. I learned how to manage it in San Antonio, which is endemically dehydration country.

 

[Bob in SF]

What Bob said. Lithium is one of the more difficult medications for us to manage. Staying on top of the dosing and levels is absolutely essential. I learned how to manage it in San Antonio, which is endemically dehydration country.

Agreed - I learned management the hard way during my 1975-1989 years at SF General - also had a Poison Center there - lithium toxicity can be dramatically sudden or very gradual - often multi-system - always needs close monitoring - and the simple fact of ageing-associated increase in neurotoxity (and other side effects) requires additional pharmocovigilance.

 

[pshrynk]

Add to all that the fact that Lithium is inherently toxic to the kidneys, so at any moment the levels can shoot up, causing toxicity... And so on. One of the main reasons that Lithium is a third line approach, if that. Men and post menopausal women get Depakote and fertile women get Tegretol (which has its own problems) or Trileptal. Bipolar disease is not a Primary Care problem.

 

[Bob in SF]

Bipolar disease is not a Primary Care problem

Amen.