#17 Komiskey - Lithium and other Metals Flashcards
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?
Increase. Thiazide, ACE inhibitors, ARBs, NSAIDS and clonazepam will also increase Li levels.
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?
Acetazolamide or alkalinizing agents like sodium bicarbonate
Chart: Patients exposed to lithium for different periods of time noticed a large decrease in GFR at what time period?
15 years
What organ is most sensitive for uranium toxicity?
kidney
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?
1978 decrease
Which type of lead will have the most effect on the kidneys?
inorganic; Organic –> bone, liver, CNS
What are the 3 forms of mercury?
elemental, inorganic, organic
Your patient is a teacher and comes in with mercury poisoning. What is a likely source of his poisoning?
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.
AM comes in fearful of mercury poisoning. After discovering that she swallowed organic mercury what is the rate of GI absorption?
90%
Elemental –> 80% via inhalation
Inorganic –> 10% GI
What are the target organs of Hg?
kidney and CNS
Your patients child was born in 2000 and has been diagnosed with Autism. What vaccine preservative might have been used?
Thimerosal
What are sources of Cadmium poisoning?
Volcano Natural rock weathering copper, lead and zinc smelting Cigarette smoke Forest fires food
Where in the kidney does Cd accumulate?
proximal renal tubular and glomerulus
What protein in the body can bind Cd?
Metallothionein
What are the two main organs affected by the itai-itai disease?
bone (osteomalacia, osteoporosis)
kidneys
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?
Cook rice in water 5-6X the volume of the rice. It can reduce the arsenic up to 50%.
An ideal chelate should be _____ soluble and have a __________ affinity for essential metals.
water; low
What is an advantage of using CaNa2 -EDTA over dimercaprol?
In addition to lead it can also bind with iron.
When is dimercaprol contraindicated?
pregnancy
HTN
kidney disease
What is an advantage of Dimercaptosiccinic acid (DMSA)?
It can be given orally for lead poisoning. EDTA is IV.
What metals does DMSA have an affinity for?
As, Pb, Sb, Hg, Bi and related elements