drcute
Forum Newbie
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A 19 years 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 of77 ug/ml(therapeutic range=40-100).which of the folowing is the most appropriate next step in managemen?
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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| klimt
Forum Guru
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A? medications (especially valproic acid) may be hepatotoxic => abnormal bleeding
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| chinda11
Forum Junior
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E. Valproic acid is causing the bleeding. Stop that and see if the symptoms resolve.
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| ram3
Forum Guru
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guys look at the question valproic acid is in the therapeutic range so it is not a probem lithium is not you are not reading the question
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| doc_clotaire
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I will check platelet count first to see what 's going on with this dude
Epistaxis is most likely a platelet problem
I go with C
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| ram3
Forum Guru
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Before checking platelet count first step is discontinuation of drug big time
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| hanwin
Forum Senior
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| arlete
Intern in 2009!!!!!
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Let's not forget: side effect is different from overdose. A drug may be causing side effect(s) even within normal therapeutic range...
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| sailing boat
Forum Elite
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so wht would u mark as the answer
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| arlete
Intern in 2009!!!!!
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C
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| Justice
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(C)
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| ssrpk
Forum Fanatic
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yeah first of all we should document that low platelet is the culprit then explore possible reasons for that...its always not to assume
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| dr in trouble
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i am with C too
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