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Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease

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I was informed that I was in Stage 3 Chronic Kidney Disease, on October 11, 2013. My GFR over the past three months has been 44, 41, 32. I am Bi-polar too so my Nephrologist has told my Psychiatrist that I must be taken off of Lithium. I am currently on a 6 wk phase out of this medication. I am very concerned about my mood reaction to this change. What are the concerns I need to keep in mind during this time? Also, I hear two sides of the drinking water story. Some say drink a lot, others say drink only a little. Which is it?
Posted Thu, 19 Dec 2013 in Kidney Conditions
 
 
Answered by Dr. Avinash Ignatius 31 hours later
Brief Answer: Dear XXXXXXX XXXXXXX Detailed Answer: Although Litihium is the best drug for bipolar, it does in a few people cause a problem in the kidneys on long term use. At this stage it is recommended you stop the Lithium and shift on to alternative medications ( many are available). Lithium also can cause a tendency to pass large amounts of urine(polyuria) in some, If that happens there may be increased thirst as a consequence leading to more water intake. If this is not so in your case and you have no swelling in your feet, a fluid intake of about 2 to 2.5 lit a day is fair. In case you have swelling then you may be advised to restrict your fluid intake to 1 - 1.5 lit a day It is natural you feel worried but other therapies also work quite well.. Follow your Nephrologists' and psychiatrists' advise and taper off Lithium.
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Follow-up: Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease 24 hours later
I have CKD phase 3 (not phase 1, as listed under the Medical History section). My GFR has now moved up from 32 to 45. But I don't think that was related to coming off of lithium since on the date of that lab test I was only 2 days into the 6 week phase out schedule. My most recent lab, 2 days ago, showed a GFR of 45 again and I am ending the 3rd week out of 6 on the lithium phase off schedule. Is that a good sign related to the lesser dose of lithium? Can I expect the number to go up even higher in one month when I'm off lithium and scheduled for another lab test at that time? My psychiatrist was not wanting to take me off the lithium due to the risks of high spikes in mood either up or down. My particular case is quite serious so she didn't want to take that chance. However, my Nephrologist called me last week to see how I was doing. He told me that he spoke to my psychiatrist and told her that if I didn't go off the lithium that I would be in dialysis in one year. That's pretty scary. Have you seen that scenario happen to any of your patients? Finally, I need help with the CKD diet. My appointment with the dietician is a few weeks off and I'm always hungry because I don't know of too many things to eat that don't have protein or sodium. I've looked at many websites but found none that presented the information clearly. Are there any common foods that are safe foods that you would suggest? My most pressing question is that I need to know if there is a daily gram allowance for protein or sodium or must it stay at ZERO? Thanks so much. ~ XXXXXXX XXXXXXX
 
 
Answered by Dr. Avinash Ignatius 40 hours later
Brief Answer: Dear XXXXXXX Detailed Answer: I presume that the GFR is an estimated GFR (eGFR) along with your blood works. The estimated GFR is a calculated measure of your renal function and has a wide variation. It may even be 10 - 30 % lower than your actual GFR. How much of the change in GFR is due to being off lithium is difficult to say, but is likely. More follow up would be needed. If you had been using any painkillers in the recent past, they could also contribute to a temporary decrease in GFR. A true GFR can only checked by either a DTPA scan or an accurate 24 hour urine collection and analysis. How fast your kidney function would deteriorate is anybody's guess, in worst case scenario yes it might happen in a years time, but is rare to progress so fast. Remember it is a low protein diet i.e. 0.7 to 0.8 gm for every kg of your body weight(not a no protein diet), so small amounts of protein is OK in diet and is actually important to take care of daily wear and tear of our body. Limit salt/sodium intake in diet. (about half a teaspoon salt per day) Avoid red meats Avoid painkillers Other than this most of the foods in moderation is acceptable. Warm regards
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Follow-up: Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease 3 hours later
Dr. XXXXXXX ~ XXXXXXX you so much for your response. It was very helpful. For clarification however, what would be my daily limit of grams of protein and also, what would be my daily limit of mg of sodium? Thanks so much! XXXXXXX XXXXXXX
 
 
Answered by Dr. Avinash Ignatius 48 hours later
Brief Answer: Dear XXXXXXX Detailed Answer: Your daily protein limit depends on your body weight It should be 0.7 gm per kg ( if you are 60kg: 0.7 x 60 = 42g/day) Salt about 3000mg/day should be adequate Warm regards
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Follow-up: Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease 4 hours later
Thank you, that was very helpful. ~Nancy XXXXXXX
 
 
Answered by Dr. Avinash Ignatius 16 hours later
Brief Answer: You're welcome, XXXXXXX Detailed Answer: Warm regards
Above answer was peer-reviewed by
 
Follow-up: Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease 24 hours later
Dr. Ignatius~ Your previous answer about daily limits of protein and sodium was so helpful but now I'm just needing some clarification. Are the numbers you gave me the limits for people with kidney disease or are they for adults in general? I know that probably is a dumb question, but my mind is so rattled by this whole CFD that I don't think straight some times. Forgive me. :) Also, I just read through your impressive list of "Professional Details" and am so thankful that I have been connected with a doctor of your high caliber. Looking through the listing of talks you have given I noticed two that I wish I had been in the audience to hear your presentation. I was wondering, do you have a transcript of Talk #1 - "Myths Regarding Diet in Renal Failure" - Oct 2002 or copies of any handouts you included in your presentation? Also, do you have the same resources for your Talk #3 - "Stress Test on Kidney Knowing Renal Reserve & Overview of the Chronic Kidney Disease" - Nov 2003? If it's possible to scan any of the information from these two talks or pull them out of your saved documents, I was wondering, could you send anything to me via attachments to an email which would be something that you are willing to make available from these two talks? My email is: YYYY@YYYY Thanks again for all of the expert help that you have been providing to me. I feel really blessed. ~ XXXXXXX M XXXXXXX
 
 
Answered by Dr. Avinash Ignatius 12 hours later
Brief Answer: Dear XXXXXXX Detailed Answer: The limits prescribed are approximate for an adult with CKD. Normal healthy adults can consume much higher. I regret I don't have any material on the topics mentioned. Wish you the best. Warm regards
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Follow-up: Would could go wrong if taking Lithium bi-polar is stopped? Stage 3 Chronic Kidney Disease 37 hours later
Dr. XXXXXXX ~ Thanks so much for the clarification. It helps me to better understand the options I have in my new CKD diet. I have an appointment with the Dietician at my Clinic on Monday so I'm hoping that will clear up the rest of my questions about food. I have lost 6 lbs over the past few weeks just because I can't figure out very well the things that I can eat that will taste good and be satisfying. With the protein & sodium limits that you gave me I feel better about adding other foods into my diet. However, I'm actually not that hungry most of the day and start feel like eating around 4pm and then eat a fairly substantial sized meal. Is it part of CKD to lose your appetite at the stage I am at? Also, where is your location? My husband and I would like to meet you sometime if you ever come to our area. If you are located in India, I don't think that will ever happen however. :) Best wishes to you as you continue to put people at ease by answering their questions about their medical condition. Thank you so much! XXXXXXX XXXXXXX
 
 
Answered by Dr. Avinash Ignatius 19 hours later
Brief Answer: You're welcome XXXXXXX Detailed Answer: Loss of appetite is not likely to be due to CKD. Your dietician should be able to guide you regarding food. I'm located in a City called Pune in India. Will keep you posted when I visit your area. Best wishes
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