As beneficial as lithium can be, it is important to be educated about the dangers of having too much in your system, which can develop into lithium toxicity (levels greater than 2.5–3.0 meq/liter). For a brief period in the early part of the twentieth century, lithium salt was actually marketed as a salt substitute for people with heart disease. It was rapidly pulled from the market after several people developed lithium toxicity and died.
So not only is maintaining a lithium level important to ensure that a person is in the therapeutic window, the range in which he’ll receive the maximum benefit, but also to make certain his level has not crept too high.
Lithium toxicity presents with a variety of physical symptoms and changes in behavior. While many of these may simply be side effects of lithium, it’s important to pay attention to a background side effect that is getting worse, such as a tremor that is much more pronounced combined with an unsteady gait and slurred speech.
Symptoms of toxicity can include:
• Upset stomach, especially nausea, vomiting, or diarrhea
• Tremor (or if the person has a tremor to begin with, the tremor gets worse)
• Unsteady gait (The person may feel light-headed, unsure of his footing, and as the toxicity progresses he may appear to stagger like someone who is drunk or “high.”)
• Slurred speech
• Delirium (This is a mental state in which people may lose track of the day, where they are and what’s going on around them. They could appear to be paying attention and then drift (often referred to as a waxing and waning level of consciousness). They may also seem sleepy, confused or giddy.)
Lithium toxicity is a medical emergency that in severe cases can progress to coma and death. If it is suspected, the person should immediately contact his practitioner and seek treatment. If the practitioner is unavailable, the patient should seek treatment in an emergency room. Once there, a lithium level is measured, through a blood test, and the person is monitored closely. Depending on how high the level has gone, interventions may be as simple as ‘watch and wait’ and recheck the level; in severe cases, putting the patient into intensive care and dialysis in order to remove lithium from the body may be necessary.
There are various reasons why a person might become toxic, including dehydration, a deliberate overdose, or inadvertently taking another medication that can prevent lithium from leaving the body and thereby cause a toxic rise in the level.
To avoid lithium toxicity, it’s important to keep hydrated in the warm weather or when ill, and to be aware of, and avoid, different medications that can elevate the lithium level.
A potential risk for people with lithium toxicity is that because its symptoms can be mistaken for other problems, including a manic or mixed episode or acute intoxication with alcohol or other drugs, lifesaving treatment may be delayed or withheld all together