dr_jojo
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A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3 weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and valproic acid. Physical examination shows no abnormalities except for dried blood in the nares. Mental status examination shows an anxious mood and slight motor restlessness. Serum studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100). Which of the following is the most appropriate next step in management?
A
) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B
) Measurement of serum bupropion level
C
) Platelet count
D
) Discontinuation of lithium carbonate therapy
E
) Discontinuation of valproic acid therapy
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| Aashi
Forum Moderator
Topics: 112
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E) Discontinuation of valproic acid therapy( FIRST d/c the offending drug and then chk the plt count)--->, the pt might have had multiple problems in the past, but treat the current problem of the pt FIRST.VAL has many S.E, and plt type bleeding is seen even with normal levels of VAL-->so d/c the drug first
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| dr_jojo
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Why we donot check the platelets First to make sure that is the cause and if it is low , and then stop the valproic
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| NE
Forum Guru
Topics: 53
Posts: 504
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restlesness and anxious mood - Li intoxication?...
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| robin082006
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C, platelet first.
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| huyniid
Forum Elite
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Because the Valproic acid level is within Rx range, and we cannot stop the drug by assuming on its S.E, furthermore the pt is not in critical state to do so, therefore checking PLT count is appropriate
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| dr_jojo
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Ya , i think checking platelets 1st
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| dr in trouble
Forum Guru
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Y dont stop Lithium, as lithium toxicity can also affect bone marrow.
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| eaguin
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stop valproic acid first because its thrombocytopenic action.
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| Dr_kholioo
Forum Junior
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( stop valproic acid first because its thrombocytopenic action.)!!
who said the patient is in thrombocytopenea unless i check his platelets count 1st ?
valproate doesn't cause bleeding valbroate cause thrombocytopenea which causes bleeding
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| lq2006
Forum Elite
Topics: 25
Posts: 355
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which one go first C or E????
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