Yeah, I'm pretty sure they typically do a level after a couple weeks. And since I had a truly atrocious doctor when I started lithium (she spent exactly 8 minutes per session with me according to her notes and documented I was functioning at a high normal level when I was coming home and going to bed in dirty scrubs, eating only chef-boy-r-dee and often uncooked, too scared to shower daily, and cycling all over the place but since I was a healthcare worker I was fine. Great logic).

Yeah, just because a place is great doesn't always mean great drs. I go to Cleveland Clinic and have had great experiences with everyone in psych except this one guy who I saw when I was on medical with lithium toxicity. For some reason nobody could explain yet nobody would fix when I was admitted they cut all my psych meds in half. And when I tried to get him to listen and fix it instead of explaining any rationale to me or doing anything he actually walked out as I was talking. I wound up screaming at the regular dr in the middle of the night because I needed Seroquel so badly and wanted to leave but had taken some sedative earlier with the promise my other meds were coming soon but they didn't. They admitted to not knowing how to handle me, said I should be in psych (for a medical issue--I needed fluids and my kidneys monitored) and when I filed a complaint the psychiatrist responded by saying I had a worse problem than I did so that I would look confused and irrational. All I wanted was to not be thrown into a huge episode because nobody cared enough to put me on my usual meds and let me have a chance at sleeping. I could have taken the complaint farther but his response made it clear he was going to keep making it sound like I was out there on Mars and he was just being rational and walked out because I wouldn't listen to him. Which wasn't true. So you can definitely get bad people anywhere. (At the same time my personal psychiatrist had taken the time to find the resident who would see me in the ER, explained my history and her suspicions and why, had him keep her updated, watched my chart from home and called me 2-3 times on a Saturday to check on me while I was in the hospital).

For sure if you haven't had a level yet you need one. That much I'm pretty sure about even if you weren't having symptoms. And since your dr didn't educate you anytime you feel like you are having symptoms that are excessive you should have your levels drawn. It has to be 12 hours from the last dose (11-13 hours usually) and otherwise is not a big deal. I had a reaction to risperdal where my blood pressure went up from my usual really low to 200/100. I went to the ER with a throbbing headache and feeling sick and with swelling in my legs. They were all weird about my requesting a level be drawn but it was very hot and I was feeling nauseous and that's enough to justify a level. Anytime you are sick enough to be at an ER they should draw a level to be sure. It won't be really meaningful unless it happens to be 12 hours out but if it comes back high then you know it was probably really high at 12 hours. With my 2nd toxicity it was drawn at maybe 20 hours and my level was I think 2.9 so quite high and if it had been drawn at 12 it would have been really high.

The good thing is that if it is high IV fluids help quickly. I actually only had them once although the 2nd time I'm sure I should have but the only way I was getting to the hospital was via ambulance and I wasn't going to the local hospital for any reason as I had a very bad experience with them and they can't handle that kind of thing anyway but Cleveland is 2.5 hours from here and I couldn't ride that long without being sick in the car. So my logic kind of failed and I refused to let my mom do anything.

I hope it goes ok tomorrow. Let me know how you are doing.