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Q: Previous Lithium Toxicity, Using Low Doses Now
In reference to the recent (March) question regarding lithium and kidney
function, have you had any experience with people who become unable to tolerate
normal lithium doses yet do not function well without it, being able to tolerate
a tiny dose (300 mg, blood level around .4) and do well?
I had toxicity 2 years ago for a prolonged period and since then
get toxicity symptoms very easily. I tried being off totally; I was miserable.
Two days after re-starting I was better. I have to monitor how I feel closely
and be sure I get lots of fluids (I have now developed diabetes insipidus as
well), but the 300 mg is so important to me that my family doctor, psychiatrist,
and nephrologist all agreed to let me continue it at this point.
My doctor has 3 patients including me who do this super-low dose
thing. One had high creatine and the other had toxicity like me.
Just wondering if this is an option for more people, or if I've
just been very fortunate.
Dear Anon --
Thank you for sending me this story. It may be useful for me in the future. So
far, reviewing cases in my head, I can only think of a few cases of severe
lithium toxicity I have dealt with. In those under my care I think we always
went on to other approaches, so never encountered this situation you describe,
where a low dose seems so effective -- as though something in the kidney or
brain was different after the toxicity episode such that a tiny dose was
sufficient.
As you have learned, we generally use the creatinine level as a marker for
kidney function. And we generally avoid using lithium when creatinine levels
are already elevated. Sounds like your doctor is careful, thoughtful, and has
more experience in this particular realm than I do. Having a nephrologist review
the whole situation and sign off on it adds more reassurance. Sounds like you
and your team have done an excellent job thinking it through. Congratulations.
I hope that continues to go well --
Dr. Phelps
Published July, 2008
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