First time: nausea. HOrrible nausea. I actually was toxic for a very long time b/c I missed a level when I had stomach flu. Then work was busy and I didn't get it done for a few weeks and at that point my therapist announced she was moving to another country in a few weeks. So everything thought it was stress, an ulcer (had one of those too) and I had my gall bladder tested. I had lithium levels done but they were always fine b/c I had not taken the drug enough days without vomiting it up. Eventually I stayed off work and forced myself to not throw up until we got a level and that was toxic. Just before that was done my therapist happened to walk behind me and noticed I was off balance and more shaky than usual after he started observing more, so he called my pdoc.

2nd time was more insiduous. I actually went to the ER because I was hallucinating, not normal for me. When asked about toxicity symtpoms I said no and then when the dr was teaching the resident and going through things I realized "oh yeah, I have been nauseous, had diarrhea, been unsteady, tremors are worse, headaches for a few weeks". That time my level was really high, I think 1.9 40 hours after a dose.

3rd time I just got SICK. I was in the car almost home and told my mom I was going to vomit so she tried to fly home. I had to jump out and vomit in the snow. I threw up and had diarrhea for a long time. It's gross but both times I've had toxicity at home I've been so sick I've peed my pants and laid in it between throwing up. I didn't bother going to the ER that time because I was so sick my level would have been lowered naturally. My mom almost called an ambulance because she was afraid of how sick I was. She said she'd never seen/ heard anyone that sick. But the worst of it ended in a matter of 2 hours. I'm sure I should have gone in for fluids but my local hospital is not good with psych issues and I didn't feel good enough to ride 2.5 hours to my hospital.

Toxicity is tricky because the symptoms can vary and aren't always consistent. Each of mine was really different. For sure any time you are nauseous and/or having vomiting/diarrhea you should have a level drawn. Rule of thumb for me was if in doubt get a level. (I tended to get slightly toxic when I was hot for too long and a lot of water and salt would help but it took playing with labs to learn that).