THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, August 10, 1995 TAG: 9508100476
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY FRANCIE LATOUR, STAFF WRITER
DATELINE: CHESAPEAKE LENGTH: Medium: 95 lines
Carol Heilman isn't the obvious target for health warnings about the city's salty water.
She doesn't suffer from high blood pressure. She doesn't have kidney problems or a weak heart.
But her daily pot of coffee, made with tap water, nonetheless threw her physical and emotional health off balance.
Heilman takes lithium, one of the only drugs known to combat manic depression. What she didn't realize was that the extra salt from the water she used in the coffee flushed the lithium out of her bloodstream.
Heilman is one of a small number of Chesapeake residents who use lithium and who may be in danger from drinking the city's tap water.
For the past month, Chesapeake's water has had extremely high chloride and sodium levels. While the increased salt content poses no health risk to the majority of residents, it can be harmful to those on sodium-restricted diets.
Chesapeake health department officials have already alerted patients with more obvious reasons to avoid salt - high blood pressure, heart disease or kidney failure. But nothing has been said of the dangers to patients on lithium, which several doctors said Wednesday is unusual in that it shares certain properties with sodium.
Dramatic increases in a person's salt intake force the kidneys to work harder to keep the level of sodium in the body constant.
But in removing the excess salt, the kidneys also excrete lithium, an element found in trace amounts in the bloodstream in a form called lithium carbonate.
Likewise, if lithium patients suddenly cut salt intake, the kidneys may retain too much lithium, potentially poisoning the patient.
``Lithium kind of hitches a ride on the sodium as it travels through the body,'' said Dr. Jay Sherr, an assistant professor at the University of Maryland School of Pharmacy. ``So when the body has to get rid of (extra) sodium, it sort of looks at the lithium and says, `Well, this looks like sodium,' and tends to flush it out with it.''
Without lithium supplements, people with manic depression - also known as bipolar disorder - can fall back into the cycle of irrational highs and depressive lows that defines the disease. But the supplement has to be just right: Too much lithium in the blood can cause disorientation, seizures and even kidney or heart failure.
Heilman described the feeling of mania as losing touch with reality.
``I start spending money like crazy - money that may or may not be there,'' she said. ``And you don't think there are any consequences, ever.
``And of course, the double-edged sword is, the higher you go up, the harder the depression is when you fall.''
Heilman's first clue to the cause of her problem came last summer, when a routine blood test showed her body was not retaining the same amount of lithium it had before.
``There were just major swings in the lithium counts that we couldn't account for,'' said Heilman, who lives in Great Bridge.
Her doctor said those levels would drop only if she had drastically changed the amount of salt in her diet.
``We went through this list of anything and everything that could possibly interact with lithium,'' Heilman said. ``When we got to salt, I dismissed it, because I thought it was table salt. I wasn't thinking about tap water.''
Even if she had thought of drinking water, Heilman said, she might not have made the connection: Though she drinks a lot of coffee and iced tea, she doesn't drink much tap water.
``Then I said, `Back up. I've moved to Chesapeake,' '' Heilman told her Virginia Beach psychiatrist. ``I know it gets pretty bad there sometimes.''
It was then that Heilman and her doctor began to test their hypothesis. For several weeks, Heilman alternated between bottled water and city tap water. With each change, she had her lithium level measured. And with each change, the numbers rose and fell.
``I was fortunate,'' Heilman said. ``I had a doctor who didn't just boost my medication to a toxic level.''
Dr. Barbara A. Frivush, chief of pediatric nephrology at Johns Hopkins Hospital, agreed that an excessive amount of salt makes it harder for manic-depressive patients to maintain in the bloodstream the amount of lithium they need.
But she also said the warning will not apply to the overwhelming majority of Chesapeake residents.
``I would think probably very few people are going to need to worry about this,'' Frivush said. ``Lithium is not a very common drug.'' ILLUSTRATION: Color photo
Salty drinking water is a health risk to Carol Heilman, who takes
lithium to combat manic depression.
Staff graphic
Kidneys and excess sodium
Source: The Marshall Cavendish Encyclopedia of Family Health, Mayo
Clinic Family Health Book.
For copy of graphic, see microfilm.
KEYWORDS: CHESAPEAKE CHLORIDE SODIUM LITHIUM by CNB