Can lithium toxicity occur even when a patient is on a stable dose and complying with doctor's orders?

Lithium toxicity can indeed occur even when a patient is on a stable dose and adhering to their medication regimen. This is primarily due to several factors that can influence lithium levels in the body. These factors include changes in kidney function, fluid intake, dietary sodium levels, and interactions with other medications. For example, dehydration from illness, changes in diet, or the use of medications that affect renal function can lead to increased lithium levels, resulting in toxicity.

Because of these variables, it is essential for clinicians to monitor lithium levels regularly even in patients who appear to be stable on their prescribed dose. This monitoring helps to detect any changes in lithium levels that could lead to toxicity before they become severe. Therefore, while consistent compliance with treatment is important, it does not entirely eliminate the risk of toxicity due to the inherent unpredictability of how the body handles lithium over time.