rpn1

What about people who are functional on methadone? What about people from all walks of life struggling emotionally/mentally with there lives who don't want to give up. I know of healthcare workers who are challenged by chronic emotional/mental feelings who charge on and don't give up. Should only emotionally balanced people be healthcare workers? Who is balanced? Don't we all have propensities to be a little off...some are too aggressive, some are too manipulative, some are I think those who suffer can offer deeper insights, compassion, and tolerance. You should lobby for your rights to help not just yourself but all others who suffer like you and are afraid to come forward. Nursing of all professions should be more compassionate, tolerant, and accommodating. If we reject our own on this basis, how can we encourage patients to go forward, go back to school, or seek employment. I'm sorry that there is so little tolerance for you in the system...I hope you can find the courage to stand-up for yourself and to change the short-sightedness of those making these decisions.

once ingested, regular release preparations produce peak serum lithium levels in 1-3 hours, compared with 4-12 hours after ingestion of sustained release preparations (such as lithobidr). lithium initially occupies a volume of distribution of 0.4 liters per kg of body weight (approximately equivalent to the vascular space). then, over the next 6-8 hours, the drug gradually moves intracellularly and achieves a final volume of distribution of 0.6-0.9 l/kg (equivalent to the total body water). the highest levels are found in the brain and the kidney where lithium exerts most of its toxic effects.lithium is excreted almost entirely by the kidney. however, anywhere from 60-75% of the filtered load is reabsorbed in the proximal tubule. since lithium is handled by the kidney in a manner very similar to sodium, any underlying condition with volume or sodium depletion will result in increased lithium reabsorption. for example, patients with vomiting, diarrhea, dehydration, congestive heart failure, excessive exercise, or even a low sodium diet are at risk for lithium toxicity via increased reabsorption of the cation at the level of the proximal tubule. lithium toxicity typically occurs in one of three scenarios: acute overdose in a patient who does not normally take the drug, acute overdose in a patient chronically taking lithium (acute-on-chronic), or chronic toxicity resulting from accumulation of the drug during therapeutic use. acute and acute-on-chronic lithium exposures occur as the result of accidental or suicidal ingestion of excessive amounts of lithium. generally, toxicity resulting from chronic accumulation of lithium is more severe. in addition to sodium depletion, other factors that can contribute to chronic toxicity include concomitant drug therapy with drugs that decrease glomerular filtration rate (gfr) such as angiotensin converting enzyme (ace) inhibitors or nonsteroidal anti inflammatory agents, and the development of nephrogenic diabetes insipidus. lithium is the most common cause of drug induced nephrogenic diabetes insipidus which is characterized by polyuria, polydipsia, hypernatremia, and low urine osmolality. this condition causes volume depletion, which in turn results in increased lithium reabsorption and subsequent toxicity. hope this helps ps:what's dd?