INPATIENT/ ER/ CLINIC/ OTHER - ER PATIENT PROFILE - 49 yo female, involuntary movements, tremors, and ataxia RELEVANT HX - bipolar disorder treated with stabledose of lithium over years, recently diagnosed with hypertension QUESTION - most likely her hypotensive agent is? A amlodipine
B hydrochlorothizide
C metoprolol
D prazosin
E clonidine
You know - I agree with this, but are these the symptoms of lithium toxicity?
I mean - tremors / ataxia / involuntary movements? I would be looking for something along the lines of nephrogenic DI or hypothyroidism but medscape says that these symptoms would be seen in a lithium toxicity case so I think that this is the best choice. http://emedicine.medscape.com/article/815523-overview
what is the question?is it asking us to find out which drug is causing hypertension in this patient as a result of its interaction with lithium OR
we have to tell the drug for treating the newly diagnosed hypertension??
what is the question?is it asking us to find out which drug is causing hypertension in this patient as a result of its interaction with lithium OR
we have to tell the drug for treating the newly diagnosed hypertension??
this pt most likely developed lithium toxicity Lithium is almost exclusively excreted by kidneys Most of filtered lithium is reabsorbed in proximal tubule Lithium reabsorption follows sodium reabsorption So anything that increases proximal tubular absorption of sodium also increases lithium levels and elevates the risk of lithium toxicity Thiazide diuretics cause volume depletion, because of this kidneys try to retain sodium and water NSAIDS also cause lithium toxicity by causing relative ischemia (prostaglandin inhibition) leading kidneys to sense there is not enough intravascular volume and start retaining sodium and water This is the same reason that NSAIDS are relatively contraindicated in CHF Lithium has a very narrow therapeutic index and toxicity almost typically occurs at blood levels of 2 mEq/L Important clinical manifestations include neuromuscular excitability, irregular coarse tremors, fascicular twitching, agitation, ataxia, and delirium Hemodialysis is the most effective way of acutely reducing blood lithium levels The other drugs mentioned in the choices do not cause lithium toxicity
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