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Which mood stabiliser does this adverse effect point to, and is it toxicity?
More, if you want it
What new problem does the patient on a mood stabiliser report?Tap a term: its definition, what you can do with it, and how often the exam asks it.
You can: Name acute pancreatitis when a bipolar patient has epigastric pain to the back and a very high amylase.
Definition: a serious drug rash that lamotrigine causes after fast dose rises.
You can: Name Stevens-Johnson rash when a rash follows a fast rise in the lamotrigine dose.
Definition: a high blood prolactin level, caused by risperidone.
You can: Name hyperprolactinaemia when a man on risperidone has breast growth.
Definition: passing large amounts of urine, an expected lithium effect.
You can: Name polyuria as an ordinary lithium side effect.
Definition: a light shake of the hands, an expected lithium effect.
You can: Tell fine tremor from coarse tremor by the other signs that come with the shake.
Definition: an underactive thyroid gland, caused by lithium in about 10% of patients.
You can: Name hypothyroidism when a woman on lithium gains weight and feels constipated and tired.
Definition: a high blood calcium, caused by lithium through hyperparathyroidism.
You can: Name hypercalcaemia when a patient on lithium has a high blood calcium.
Definition: a heavy shake of the hands, a sign of lithium toxicity.
You can: Tell coarse tremor from fine tremor by confusion, ataxia or seizures alongside the shake.
Definition: eye flicking with the fast beat downwards, a sign of severe lithium toxicity.
You can: Tell downbeat nystagmus from ordinary lithium effects by its place among severe toxicity signs.
Definition: a drug reaction with high fever, sweating, diarrhoea and ataxia.
You can: Tell serotonin syndrome from lithium toxicity by the presence of a high fever.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
- : sudden inflammation of the pancreas, a recognised harm of sodium valproate.
A drug-specific adverse effect is a characteristic harm that one mood stabiliser causes.
A drug-specific adverse effect is a characteristic harm that one mood stabiliser causes. Sodium valproate causes , a sudden inflammation of the pancreas. Lamotrigine causes a Stevens-Johnson rash with fast , which means the dose is raised too fast. Risperidone causes hyperprolactinaemia, a high blood level of the hormone prolactin. Hyperprolactinaemia from risperidone can cause gynaecomastia, which is breast growth in a man.
Valproate pancreatitis is rare, usually appears early in treatment, and occasionally proves fatal. Books list pancreatitis alongside blood count changes and raised ammonia as valproate harms. A raised urine amylase from saliva with a normal serum amylase is a look-alike seen in feigned illness. Risperidone usually raises prolactin even without symptoms, so prolactin needs close monitoring. Aripiprazole has no effect on prolactin.
Fiona MacLeod has bipolar disorder and takes sodium valproate. Fiona arrives at the acute medical unit vomiting, with a very high amylase. Fiona says, "The pain came on suddenly and goes straight through to my back."
Lithium causes and tremor. Valproate can also cause tremor. Severe epigastric pain radiating to the back with a very high amylase in a bipolar patient is valproate pancreatitis.
Valproate causes a dose-related tremor, so tremor alone does not separate valproate from lithium.
Analogy
A hospital post room sorts each parcel into one pigeonhole by its address label. Each sign is a parcel, its typical adverse effect is the label, and the drug is the pigeonhole. Pancreatitis carries the valproate label, so the parcel lands with valproate.
Where the analogy breaks: a parcel has one label, while lithium owns several signs and shares nausea and ataxia with serotonin syndrome.
5 more sections on Mood stabiliser adverse effects: valproate pancreatitis, lithium side effects, lithium toxicity and more
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