#17 Komiskey - Lithium and other Metals

Question 1

Your patient is currently on lithium for treatment of their bipolar disorder. Their cardiologist just placed them on a loop diuretic. What will this do to their Lithium levels?

Answer 1

Increase. Thiazide, ACE inhibitors, ARBs, NSAIDS and clonazepam will also increase Li levels.

Question 2

Your aunt calls complaining of depression. Her bipolar disorder has been under control for years. You ask her what medication changes have taken place. What is a likely response?

Answer 2

Acetazolamide or alkalinizing agents like sodium bicarbonate

Question 3

Chart: Patients exposed to lithium for different periods of time noticed a large decrease in GFR at what time period?

Answer 3

15 years

Question 4

What organ is most sensitive for uranium toxicity?

Answer 4

kidney

Question 5

Chart: In what year was the ban on lead paint enacted and what effect did it have on lead poisoning in children 1-5 years of age?

Answer 5

1978 decrease

Question 6

Which type of lead will have the most effect on the kidneys?

Answer 6

inorganic; Organic –> bone, liver, CNS

Question 7

What are the 3 forms of mercury?

Answer 7

elemental, inorganic, organic

Question 8

Your patient is a teacher and comes in with mercury poisoning. What is a likely source of his poisoning?

Answer 8

Teacher is not one of the occupational sources (miner, dental office, thermometer manufacturer, paper mfg)Food chain is likely. He is a teacher and needs a quick meal.

Question 9

AM comes in fearful of mercury poisoning. After discovering that she swallowed organic mercury what is the rate of GI absorption?

Answer 9

90%
Elemental –> 80% via inhalation
Inorganic –> 10% GI

Question 10

What are the target organs of Hg?

Answer 10

kidney and CNS

Question 11

Your patients child was born in 2000 and has been diagnosed with Autism. What vaccine preservative might have been used?

Answer 11

Thimerosal

Question 12

What are sources of Cadmium poisoning?

Answer 12

Volcano
Natural rock weathering
copper, lead and zinc smelting
Cigarette smoke
Forest fires
food

Question 13

Where in the kidney does Cd accumulate?

Answer 13

proximal renal tubular and glomerulus

Question 14

What protein in the body can bind Cd?

Answer 14

Metallothionein

Question 15

What are the two main organs affected by the itai-itai disease?

Answer 15

bone (osteomalacia, osteoporosis)

kidneys

Question 16

KM is concerned about arsenic in his rice. What procedure is recommended to reduce the arsenic and by what level would this procedure reduce the arsenic content?

Answer 16

Cook rice in water 5-6X the volume of the rice. It can reduce the arsenic up to 50%.

Question 17

An ideal chelate should be _____ soluble and have a __________ affinity for essential metals.

Answer 17

water; low

Question 18

What is an advantage of using CaNa2 -EDTA over dimercaprol?

Answer 18

In addition to lead it can also bind with iron.

Question 19

When is dimercaprol contraindicated?

Answer 19

pregnancy
HTN
kidney disease

Question 20

What is an advantage of Dimercaptosiccinic acid (DMSA)?

Answer 20

It can be given orally for lead poisoning. EDTA is IV.

Question 21

What metals does DMSA have an affinity for?

Answer 21

As, Pb, Sb, Hg, Bi and related elements