Symptoms of
In mild lithium toxicity, symptoms include weakness, worsening tremor, mild ataxia, poor concentration and diarrhea. With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge (Bauer and Gitlin 2016).
Taking a Lithium Test. A test to measure lithium levels is performed on a blood sample. Usually, your blood will be drawn in a medical office or laboratory, and the sample will be sent to a lab for analysis. Point-of-care testing is another method of measuring lithium levels.
However, research has shown that lithium toxicity can occur at blood lithium levels around or above 1.5 milliequivalents per liter (mEq/l). Moderate-to-severe cases typically develop at levels between 2.5 and 3.5 mEq/l.
Serum lithium levels should be checked between 4 to 7 days following initiation and the dose adjusted accordingly. Serum levels should be repeated after every dose change and then every week until dosage has remained constant for 4 weeks. Blood samples should be taken 12 hours after the previous dose of lithium.
Adults and children 12 years of age—600 milligrams (mg) 2 times a day, or 3 times a day up to 1200 mg per day. Children younger than 12 years of age—Use is not recommended.
Avoid drinking alcohol or using illegal drugs while you are taking lithium. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication. Avoid low sodium diets and dehydration because this can increase the risk of lithium toxicity.
Baseline testing for lithium includes electrolytes, creatinine, GFR, BUN, thyroid function tests, EKG, CBC, and weight. Tests should be monitored every 4 to 6 months and more often in elderly patients and those with cardiovascular disease.
For adults with bipolar disorder there was consensus that the standard lithium serum level should be 0.60‐0.80 mmol/L with the option to reduce it to 0.40‐0.60 mmol/L in case of good response but poor tolerance or to increase it to 0.80‐1.00 mmol/L in case of insufficient response and good tolerance.
The most common side effects of lithium are feeling or being sick, diarrhoea, a dry mouth and a metallic taste in the mouth. Your doctor will carry out regular blood tests to check how much lithium is in your blood.
Symptoms of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, and vision changes. If you experience these, you should seek immediate medical attention to check your lithium levels.
Studies have shown that the average lithium-induced weight gain is between 4.85 and 22 lbs. Also, keep in mind that different causes contribute to lithium-induced weight gain - we will discuss them in more detail below.
Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild.
Short-term side effects can include nausea and diarrhoea, muscle weakness or a dazed feeling. A long-term side effect can be weight gain. Your lithium dose needs to be adjusted to suit you. Go for your blood tests to make sure you have the right amount in your system.
Adverse effects were the most common cause for lithium discontinuation. Among the adverse effects, diarrhoea, tremor, creatinine increase, polyuria/polydipsia/diabetes insipidus and weight gain were the top five reasons for discontinuing lithium.
Lithium is not recommended in patients with renal impairment. It is also not recommended in patients with cardiovascular disease. Lithium causes reversible T wave changes and can unmask Brugada syndrome. A cardiology consult is necessary if a patient experiences unexplained palpitations and syncope.
Chronic lithium treatment also exerted some effects on motivational behavior. Similar to lithium blockade of GBR-induced enhancement of learning, lithium only exerted attenuating effects in GBR-induced increased motivation.
Similarly, lithium itself can have what's known as a "paradoxical" reaction where it actually creates more anxiety and depression, which is another important reason not to use lithium without talking to your doctor. Lithium can take weeks to reach its full effectiveness.
Lithium reacts violently with MOISTURE, WATER or STEAM to produce heat and flammable and explosive Hydrogen gas and toxic Lithium Hydroxide.
Lithium (Eskalith, Lithobid) is one of the most widely used and studied medications for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve or prevent bipolar depression. Studies show that lithium can significantly reduce suicide risk.
People taking lithium should avoid drinking alcohol. Not only can alcohol worsen bipolar disorder symptoms, but it can also intensify side effects caused by lithium, including dizziness and drowsiness. Additionally, taking lithium while drinking may make the medication less effective, leading to more mood swings.
Doses are typically between 900 mg and 1200 mg per day, but again, the level of the drug in the blood is monitored and a dose that maintains that level is used. Lithium has numerous interactions with other drugs. The potential toxic effects of lithium can be enhanced by using numerous other drugs.
Take your lithium each night at the same time. You need to take it at night because blood tests need to be done during the day, 12 hours after a dose (see Section 4 'Blood tests after starting to take lithium').