1 Alan, 40, has bipolar disorder, which is controlled on lithium (slow-release p
ID: 85507 • Letter: 1
Question
1
Alan, 40, has bipolar disorder, which is controlled on lithium (slow-release preparation, 450mg bd). He presents to the surgery feeling tired, weak, shaky and complaining of nausea. Your first thought is that he has flu and has been overdoing things. The plasma lithium concentration result is available the next morning and is 1.6mmol/L (therapeutic range for chronic maintenance 0.6-1.2mmol/L). The comment on the report draws your attention to the time of the last dose and of sample collection, stating it to be about eight hours post dose. The previous lithium concentration 12 months earlier was 0.8mmol/L. You wonder about the possible explanations for an increase of Alan’s lithium concentration into the toxic range. What medical causes might result in this change? A review of his medications shows no obvious candidates for a drug interaction. Further questioning reveals that to lose weight, Alan has taken up jogging every morning, with predictable aches and pains in muscles and joints. In response, he has been taking ibuprofen bought from the local supermarket. Is the ibuprofen significant in this case?
2
A suspected pregnant woman presents with a decreased AFP level. What is the significance of this level and what protocol should be followed to ensure that these are the correct results?
Explanation / Answer
Ibuprofen is taken for the pain in muscles etc but it also have adverse effect which the Alan have like nausea, dizziness, weak and tired. He will be using ibuprofen in high quantity for getting relief from pain but increased concentration of ibuprofen have side effects also he is taking lithium tablets for bipolar syndrome. The excess of these both drugs is significant for the sickness of Alan.
Ans-2 The AFP is alpha fetoprotein. It is secreted by the foetus. The low level of AFP indicate that the baby may have Down syndrome. By determining the correct age of foetus we can ensure that the results are correct or not. To cross check the results the foetus ultrasound and amniocentesis are performed.
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