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| * nbme 1 q |
| | #176799 |
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19 y/o man comes to the Doc because of frequent nosebleeds over the past 3 wks. He has bipolar d/o and currently well controlled with lithium carbonate, bupropion and valproate. PE shows no abnormalities except dried blood in the nares. Mental status exam shows anxious mood and slight motor restlessness. Serum studies show a lithium level of 1.3 mEq/L (0.6-1.2) and valproate level 77 micg/mL (40-100). Which of the following if the most appropriate next step in management?
a. measurement of serum AST activity
b. measurement of buprpion level
c. platelent count
d. discontinue lithium tx
e. discontinue valrpoate tx
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| * Re:nbme 1 q |
| #731880 |
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The Only thing I remeber about Li is that it can induce Nephrogenic Diabetes Insipidus
which may be the cuase of the Pts Mental Changes
But not sure how if there is any relation to Nose Bleed or interaction w/ bupropion or valproate |
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| * Re:nbme 1 q |
| #731884 |
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c?
Accessmedicine showed this for Valproic acid has been reported to cause thrombocytopenia or abnormal coagulation parameters (e.g., hypofibrinogenemia) or inhibit of the secondary phase of platelet aggregation. The incidence of thrombocytopenia appears to be dose-dependent. Evidence of hemorrhage, bruising, hematomas, petechiae, or a disorder of hemostasis/coagulation (e.g., prolonged bleeding time) is an indication for reduction of the dosage or withdrawal of therapy.
But then you can also chose e! |
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| * Re:nbme 1 q |
| #731888 |
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well, what i know that you can not stop lithium in a bipolar pt suddenly, so, certainly it is not D |
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| * Re:nbme 1 q |
| #731903 |
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agree w/ triple better to check C 1st, and maybe reduce the levels or replace w. another one rather than abruptly discontinuing it.
But one question I have is will the Mx change regardless of the Coagulation Findings??
If not would it be a waste of time to do C?? |
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| * Re:nbme 1 q |
| #740578 |
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Ben u have good point....well i'll go with C though I was wrong as went with E
We should go with C and if platelets are low we can take off Valproic Acid an continue with rest of stuff
Sammy having normal level does't mean u cant have side effects |
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| * Re:nbme 1 q |
| #740623 |
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how abt A ..heptic toxicity by valporic acid lead to inc in AST .....which can lead to derannge n clotting factor.. |
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