Lith-c.

Lithium carbonicum

There is a slowness in affairs which ripens them, and a slowness which rots them.
[Ralph Waldo Emerson]
Signs
Lithium carbonate.
CLASSIFICATION The silvery-white metal lithium is an element of the alkali metal series – group 1 of periodic table -, along with sodium, potassium, rubidium, cesium, and francium. It is the lightest member of the group and, moreover, the lightest of all metals, with a density only half about that of water. When carefully placed on the surface of water, a small piece of lithium will whirl about eratically, very much like a small boat out of control. Natural lithium contains two isotopes; there are three artificial radioactive isotopes; all isotopes are unstable.
DISCOVERY It was discovered in 1817 by the Swedish chemist Arfvedson in the mineral petalite. Arfvedson named the new element lithium – from Gr. lithos, stone – because it was discovered in a mineral, contrary to its close relatives sodium and potassium, which were first discovered in organic products. Arvfedson soon detected lithium in other minerals as well, and the Swedish chemist Berzelius identified it in the mineral springs of Karlsbad and Marienbad. Much later, the mineral water of Vichy in France owed its widespread popularity to the presence of lithium salts in the water.
OCCURRENCE Lithium’s occurrence in the earth’s crust is 20 ppm [= 20 mg per kg]. It does not occur free in nature; combined it is found in small amounts in nearly all igneous rocks and in the waters of many mineral springs. Lepidolite, spodumene, petalite, and amblygonite are the more important minerals containing it. Lithium is presently being recovered from brines of Searles Lake, in California, and from Nevada, Chile, and Argentina. Large deposits of spodumene are found in North Carolina. 1
PROPERTIES Lithium is the hardest of the alkali metals. It reacts violently with inorganic acids and presents fire and explosion risk when exposed to water, nitrogen, acids or oxidizing reagents. It becomes yellowish on exposure to moist air, but does not react with oxygen at room temperature. Lithium imparts a beautiful crimson colour to a flame, but when the metal burns strongly the flame is a dazzling white. Since World War II, the production of lithium metal and its compounds has increased greatly. The metal has the highest specific heat of any solid element, and more than twice that of water. It can absorb large amounts of heat with only a slight increase in its own temperature and therefore it has found use in heat transfer applications, e.g. in experimental nuclear reactors to absorb the heat produced by the fissioning of uranium. 2,3 Due to its high reactivity lithium must be stored under liquid oxygen-free paraffin to prevent oxidation.
WATER Lithium combines readily with hydrogen. “A small amount of it is capable of combining with staggering volumes of this gas: one kilogram of lithium hydride contains 2,800 litres of hydrogen! During the World War II American flyers were provided with lithium hydride pellets as emergency portable hydrogen sources to be used if the plane crashed while flying above water: once in contact with water, the pellets would dissolve instantaneously releasing hydrogen to inflate rescue facilities, such as inflatable boats, life jackets, and signal balloon antennas. The incredible ability of lithium compounds to absorb water has found extensive use as a means of purifying the air in submarines, respirators on aircraft, and in air conditioners.”4
USES With aluminium as high-strength, low density alloys for the aircraft industry; with aluminium and magnesium as extremely tough, low-density alloys for armour plate and aerospace components; as a chemical intermediate in synthesis of organic compounds; nuclear applications. It ranks as a leader contender as a battery anode material as it has a high electrochemical potential; lithium batteries are used in portable computers, cellphones and other electronic equipment. Lithium is used in special high-strength glasses and glass-ceramics. Lithium chloride is one of the most hygroscopic materials known, and it, as well as lithium bromide, is used in air conditioning and industrial drying systems. Some organic lithium compounds [stearate, palmitate and others] retain their physical characteristics within a wide temperature range, which makes them useful in the production of lubricants for machines.
PHYSIOLOGY Marine animals have a lithium content of 1 mg per kg, while land animals have 0.01 mg per kg. Experiments with goats have suggested that lithium is an essential element for animals, as goats on a lithium-deficient diet had lower body weight gain, lower conception rates, higher absorption rates, and significantly higher mortality rates. Lithium is not considered to be an essential trace element in man but it is usually supplied to the body in drinking water. “Studies on communities differing in lithium content in their drinking water suggest that higher intakes of the mineral result in lower death-rates from heart attacks; lower number of admissions for mental disorders; lower suicide rates; lower murder rates; lower incidence of gastric and duodenal ulcers; lower incidence of gout; lower incidence of rheumatism. Low lithium levels in water were found to be 8 mg per litre; high levels were 100 mg per litre. Some South American Indian communities known for their quiet, peaceful ways and reduced incidence of arthritic complaints, gastroduodenal ulcers and heart disease have been found to have lithium intakes from their drinking water some 50 times more than the average Western World community.”5
ABSORPTION Food sources of lithium are not known as levels have not been measured. Concentrations in drinking water can range from 4-150 mg per litre and this represents the main source for most people. “Absorption of lithium is very efficient and is passive, requiring no specific absorption process. It is rapidly distributed throughout the body with highest concentrations occurring in the bones, the thyroid gland and the brain. Most excretion occurs through the kidneys into the urine and there are also losses in the sweat and saliva. The mineral crosses the placenta in the pregnant female and also appears in the breast milk of the nursing mother. All information on distribution throughout the body has come from studies on people given high doses of lithium. It cannot be detected easily in the body when the sole source is dietary.”6 In general, the body distribution of lithium is similar to that of sodium, and it may be competing with sodium at certain sites, e.g. in renal tubular reabsorption. A low salt intake resulting in low tubular concentration of sodium will increase lithium reabsorption and might result in retention or intoxication.
PLANTS Although there are no data that would support that lithium is essential for plants, alfalfa, rye, and red clover contain high amounts of it and are considered good indicators of lithium levels in the soil. Lettuce is a high accumulator of lithium, while apple, onion, and grain crops are generally low in lithium. Lithium in the soil in excess of 2 to 5 mg/kg was toxic to citrus. 7
MEDICINE The psychotropic effect of lithium was discovered in 1949 by the Australian psychiatrist Cade. Professor Smith of the University of Iowa Hospitals and Clinics summarizes the discovery thus: “Dr. John Cade watched psychiatrically ill prisoners in a Japanese POW camp in World War II. He decided they had a poison affecting their brain that he might be able to find in their blood or urine. In 1949 in Melbourne, released from captivity, he searched for the poison by injecting patients’ urine into the abdomen of guinea pigs. They died. Then he tried fractions of the urine but had a hard time dissolving uric acid so he tried more soluble lithium urate. ‘After a period of about two hours the animals, although fully conscious, became unresponsive to stimuli.’ He could turn them on their back and instead of frantic efforts to right themselves they gazed placidly back at him. It also protected the guinea pigs from a convulsive death from urate poisoning. Dr. Cade then gave lithium to ten manic patients, six schizophrenics, and three patients with major depressions. It didn’t affect the depressives and mildly calmed the schizophrenics, but it changed the manic patients dramatically. Patients who had been chronically maniacally excited, garrulous, violent, euphoric, restless, dirty, unkempt, destructive, and hard to take care of, became calmed and eventually normal. On drug withdrawal they were manic again. He published this result in the Medical Journal of Australia in September 1949. “8 Lithium’s main therapeutical use is as a mood stabilizer and in psychiatry in the treatment for mania and the prevention of manic depression and depression. Lithium must be used at a critical-level dosage – which is very close to the toxic level – if it is to have any therapeutic benefit whatever. Different individuals require different amounts of lithium to be at the critical-level dosage. Given in an acute attack, lithium is effective only in reducing mania and has no effect during the depressive phase. In the past, lithium has also been used to treat leukopenia, hyperthyroidism, Ménière’s disease, tardive dyskinesia, migraine, cluster headache, epilepsy, and premenstrual syndrome.
EFFECTS Observed effects of lithium when given in drug doses include: [1] increased turnover of noradrenaline; [2] displacement of sodium from extracellular fluids; [3] reduction of bone mineral content; [4] increased blood serum concentrations of magnesium, calcium and phosphate; [5] increased blood plasma level of parathormone; [6] reduced synthesis and release of thyroid hormones; [7] increased release of insulin enhancing formation of muscle glycogen; [8] increase in blood plasma level of anti-diuretic hormone; [9] transient increase in blood plasma level of aldosterone. 9
TOXICOLOGY Polyuria and excessive thirst are two common side effects of lithium medication. The symptoms of lithium intoxication often develop gradually. Signs of the fully developed intoxication include: coarse tremor, twitching [especially of facial muscles], muscular hypertonia with increased and sometimes asymmetrical deep tendon reflexes, seizures, attacks of hyperextension of the arms and legs, EEG changes, and a greyish hue of the skin. The patient’s sensorium may vary from confused to comatose. Organic changes may occur with therapeutic levels of lithium. These include distractibility, poor memory, disorientation, incoherence, poor concentration, and impaired judgement. These maybe accompanied by involuntary movements, ataxia, and dysarthria. The symptoms often appear insidiously and maybe unrecognised as lithium-related. “The therapeutic use of lithium carbonate may produce unusual toxic responses. These include neuromuscular changes [tremor, muscle hyperirritability, and ataxia], central nervous system changes [blackout spells, epileptic seizures, slurred speech, coma, psychosomatic retardation, and increased thirst], cardiovascular changes [cardiac arrhythmia, hypertension, and circulatory collapse], gastrointestinal changes [anorexia, nausea, and vomiting] and renal damage [albuminuria and glycosuria]. Chronic lithium nephrotoxicity and interstitial nephritis can occur with long-term exposure even when lithium levels remains within the therapeutic range.”10 The risk of lithium toxicity is very high in people with significant renal or cardiovascular disease, severe debilitation, dehydration or sodium depletion, or when using diuretics.
LONG-TERM EFFECTS The chronic side effects include mild leukocytosis, exacerbation of acne and psoriasis, hypothyroidism, and nephrogenic diabetes insipidus. “Most patients will completely recover after a lithium intoxication but for those with residual effects the sequelae will reflect cerebellar dysfunction. The most common neurologic residual signs are ataxic scanning speech, truncal ataxia, broad-base ataxic gait, incoordination of limb movements tremor of head and hands and nystagmus. Other patients may have signs of cognitive damage. These can include poor short-term memory, poor insight, limited comprehension and dementia. The majority of these signs may appear during the intoxication and persist for more than 2 months after the discontinuation of lithium. If signs continue for 6 months or longer they are often permanent [Groleau 1994].”11 “Schou et al [1970] retrospectively surveyed 30 charts and 100 charts for adverse effects in patients who had been receiving lithium for one week and one to two years, respectively. Adverse effect complaints after one week of lithium treatment was GI irritation [33%], tremor [53%], muscle weakness [40%], thirst and polyuria [60%], and weight gain > 5 kg [0%]. Thirteen percent of patients had no complaints [13%]. In the long-term group there were no gastrointestinal complaints or complaints of muscular weakness; 4% of the patients complained of tremor; weight gains of > 5 kg were listed in 11%; and polyuria and polydipsia was a complaint in 24% of the patients. Sixty-five percent of patients had no complaints. Vestergaard et al [1980] questioned 237 patients on long-term lithium. The following adverse effects were noted: polyuria and polydipsia, 70%; tremor, 45%; loose stools, 20%; weight gain > 10 kg, 20%; oedema, 10%; dermatitis, 3%; and muscle weakness, 1.6%. He noted 25% of patients had > 3 complaints, 66% had > 1 complaint, and only 10% had no complaints.”12
PROVINGS •• [1] Hering – 8 provers [5 males, 3 females], 1843-53; method: 3rd trit., single dose; 30c, twice daily for three days, followed on 6th day by alternate intake of ‘globules of the 30th and solution of the 2nd trit. and continued them for several days, without noticing anything, except a very copious sweat’; 1c, single dose; 5c, two doses; 5c, three doses; 5th dil., twice daily for three days.
•• [2] Schadde – 12 provers, 1994-95; method: 6c [six provers] and 30c [six provers], three daily doses for several days, until reactions occurred.
[1-2] Lide, Handbook of Chemistry and Physics. [3] Merck Index. [4] Venetsky, Tales about metals. [5-6] Mervyn, Vitamins and Minerals. [7] Pais and Benton Jones, The Handbook of Trace Elements. [8] Smith, Lithium continues to work well for mania; University of Iowa, 2000; website. [9] Mervyn, ibid. [10] Klaassen, Casarett and Doull’s Toxicology. [11] Perry, Lithium intoxication; University of Iowa, 1996; website. [12] Perry, Mood Stabilizer Adverse Effects; University of Iowa, 1996; website.
Affinity
Heart. Small joints. Lungs. Urinary organs. Eyes. * Left side. Right side.
Modalities
Worse: Night. Menses; after; suppressed. Stooping. Cold air.
Better: Eating. Urinating. Motion.
Main symptoms
M Disposition to weep over his lonesome condition.
M SLOWNESS. [7 provers] [S]
Two provers felt that time was passing too slowly.
Slowness of thinking [1 prover], of talking [1], of understanding [1], of acting [1].
One prover was perceived by others as being slower / quieter.
And Confusion and lack of concentration.
M – Mistakes in speaking and writing. [5 provers] [S]
Difficulty in remembering names and in concentration / focusing.
G Chilly.
Inspired air feels cold [even into lungs]. [Confirmed in proving Schadde]
G Great thirst.
Cold, warm, coffee, tea.
G < NIGHT. G > Discharges.
• “This amelioration after urinating may be compared with < on cessation of menses: Menses cease suddenly and headache comes on.” [Clarke] G > Eating.
[headache, gnawing pain in stomach, diarrhoea]
G SORENESS, as if bruised or beaten.
[bones, joints, muscles, whole body]
G Pressing from within outward.
[head, abdominal ring, perineum, chest]
G Arthritic complaints.
And HEART or EYE symptoms.
• “Very likely to be needed.” [Clarke]
Recurrent attacks of acute inflammation of the SMALL joints.
Pain in small spots.
Swelling and tenderness of finger and toe joints > very hot water.]
• “Burning stitches as if it would itch. The burning-sticking pains, in jerks from within outwards and ending in itching seems to the prover to be characteristic.” [Hering]
• “Twitching pains in all the fingers, especially in the second and third fingers of the left hand as if in or upon the bones, internally from the hand towards the extremities, throbbing, twitching, very sensitive during repose; but ceasing on pressure, on being grasped and on motion; first on the right side, then on the left.” [Hering]
G SIDES; transient pains from right to left side, or vice versa.
[confirmed in proving Schadde; headache above eyes, first right, then left; throat inflammation, first left, then right.]
• “Before the menses, the symptoms were most violent on the left side, after the menses on the right.” [Hering]
P Hemiopia; RIGHT HALF LOST.
• “On the second day of the menses, while she was reading, she was obliged to get up and go out of doors for a short time. When she came back and took up her book again, she noticed an uncertainty of vision and an entire vanishing of the right half of whatever she looked at; or if two words occurred in succession, that on the right hand was invisible. She tried each eye, alone; it was the same with both. At the same time, pain over the eyes and tension, as if bound, in the temples.” [Hering]
P Acuteness of smell – sensitiveness to odours. [3 provers] [S]
[body odours; food, esp. sausage; tobacco smoke]
P Profuse urination at night; disturbing sleep.
P Prominent for HEART problems.
Esp. when heart symptoms < bending FORWARD and > after URINATING.
• “Especially after mental agitation of a vexatious character to which she is very subject [in deficiency of the valves], a trembling and fluttering of the heart with distressing pain in the heart and as far as between the shoulders. It extends upward into the head where it is felt as an equally painful throbbing; at the same time air, on inspiration, seems so cold that it is felt unpleasantly cold even in the lungs. Lith-c. cured.” [Grimmer]
P Dry and harsh skin.
Symptoms from: Hering, Proving of Lithium carbonicum; The Amer. Hom. Review, May and June 1863.
Symptoms with [S]: Anne Schadde, Lithium carbonicum, Eine homöopathische Studie; München 2000.
Rubrics
Mind
Colours, fascinated by white [1*]. Confusion, in morning on waking [1*], while standing [1]. Delusions, sees faces [1*], sees faces on waking [1*], sees face with staring, ice-cold, blue eyes [1*]. Fear, narrow places [1*]. Forsaken feeling [1]. Feeling of helplessness at night [2/1]. Laughing, everything seems ludricous [1*]. Weakness of memory, for names of objects [1], for proper names [1]. Sensitive, to all external impressions [1*], to noise [1*], to odours [1*]. Aversion to being spoken to [1*]. Thoughtless staring [1*]. Starting from noise [1*]. Thoughts, profound [1*], vacancy of [1*]. Time passes too slowly [1*]. Bashful timidity [1*]. Weeping from forsaken feeling [1], from sympathy with others [1*].
Vertigo
Sensation as if floating [1].
Head
Enlarged sensation [1]. Pain, accompanied by obstruction of nose [1*], > while eating [2], from looking fixedly at anything [1], > rubbing [1*], pain in small spot [1]; pain as if top of head would come off [1].
Vision
Accommodation too slow [1*]. Hemiopia, right half lost [3], horizontal [2], during menses [1/1], vertical [3].
Nose
Coldness inside when inhaling [1]. Smell, acute, during coryza [1*].
Throat
Pain,> warm drinks [1*]; sore, in a dry spot [1].
Stomach
Appetite, increased after eating [1*]. Emotions are felt in stomach [1*]. Emptiness, with diarrhoea [1*]. Nausea, from body odours of others [1*], after chocolate [1*]. Pain, after drinking [1*], > after eating [2].
Abdomen
Pain, after chocolate [1*], > flexing limbs [1*].
Rectum
Diarrhoea, after chocolate [2], > eating [2], after fruit [1].
Bladder
Pain, in small spot [1*].
Female
Pain, ovaries, extending to hips [1*].
Chest
Pain, heart, before urination [2/1], during [2], > after [2; Nat-m.].
Back
Pain, cervical region, < bending head forward [1*], > bending head forward [1*].
Limbs
Heaviness, as if a heavy weight hangs on right shoulder [1*].
Sleep
Waking, from nausea [1*].
* Repertory additions: Anne Schadde, Lithium carbonicum, Eine hom. Studie; München 2000.
Food
Worse: [2]: Chocolate [= diarrhoea; nausea]. [1]: Bread; coffee [*]; fruit [= diarrhoea]; tomatoes.
Aversion: [1]: Beer [*].
Desire: [1]: Coffee [*]; ice cold water [*]; liver sausage [*]; raw onions [*]; refreshing things [*]; sweets [*]; tea [*].
* Repertory additions [Schadde].

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-POIRIER Jean,

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It is a remedy of sub-acute stage. Like Colchicum, it has rheumatic troubles with cardiac troubles.
The cardiac troubles are very discrete. The patient feels his heart and suffers from it in the morning and by bending forward, micturition ameliorates his pains and cardiac sensations.
As regards rheumatism, the important character resided in the sensation. The patient always suffers from his small joints. The pains are acute, “lancinating”, “intermittent” more marked at night. A particularly touched region : “right shoulder near the insertion of the big pectoral”.

In the urine there is always “excess of uric acid”. Very often the patient experiences some “visual troubles”, “hemiopia”. He sees only half of an object.

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-Mohanthy.N

Carbonate of lithium. li2Co3
1. This drug is useful in cases of chronic rheumatism with heart involvement, also indicated in gout with tophi in various joints.
2. Tensive and throbbing pain in head better sitting.
Headache ceases while eating.
3. Hemianopia; right half not visible.
Photophobia with pain in eyes.
4. Gnawing pain in stomach better by eating. (Anac.).
Pressure of clothes unbearable.
5. Indicated in subacute and chronic cystitis with turbid urine, mucus and red deposits.
Painful right loin.
During urination pressure in heart.
6. Cough worse on lying down.
Pain in mammary glands, which extend into the arms and fingers.
7. Rheumatic soreness in cardiac area with throbbing and stitching pain.
Palpitation.
Pain in heart before menses and before urinating; better after.
8. Swelling and tenderness of finger and toe joints; better hot water.
Pain in hollow of foot extending to knee.
9. Barber’s itch; eruptions preceded by red, raw skin.
10. Modalities : worse : morning, right side.
Better : morning rising.

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