Electrolyte Disturbances + Thyroid Disease + Vitamin B12 deficiency Flashcards
what psychiatric medication can result in hypercalcemia and hyperparathyroidism
long term lithium treatment
what are the symptoms of hypercalcemia
“bones, stones, groans, thrones, psychiatric overtones”
painful bones–> abnormal bone remodeling
renal stones–> kidney stones from hypercalciuria
abdominal groans–> ileus and abdo pain
thrones–> urinary frequency
psychiatric overtones–> depression
what is the prevalence of hypercalcemia and hyperparathyroidism in those treated with lithium
up to 10%
even higher in geriatric population
how does lithium cause hypercalcemia and hyperparathyroidism
Lithium is thought to cause hyperparathyroidism due to it altering the set point of receptors that sense calcium in parathyroid cells, and thus causing excess parathyroid hormone release
what is the definitive treatment for lithium induced hypercalcemia and hyperparathyroidism
stopping lithium
(otherwise, if its not due to lithium, parathyroidectony is the only treatment)
what symptoms can be associated with acute-onset hyponatremia
delirium
acute behavioural changes
how do most medications that can cause hyponatremia do this?
most trigger inappropriate ADH secretion
list some etiologies of hyponatremia
water intoxication (too much water in)
excessive ADH (too little water out)
poor IV fluid management post op (too little sodium going in)
general dehydration (too little sodium going in)
aldosterone or cortisol deficiency (too much sodium going out)
diuretic use (too much sodium going out)
diarrhea, burns, vomiting (too much sodium going out)
what three factors characterize SIADH
Excessive free water retention
Euvolemic hyponatremia with continued urinary sodium excretion
Urine osmolality > serum osmolality
what is PIP syndrome
Psychosis, Intermittent hyponatremia, and Polydipsia Syndrome (PIP Syndrome) is a triad of symptoms observed in psychiatric patients, particularly in those with schizophrenia and/or psychosis.[7] The underlying etiology of polydipsia (compulsive water consumption) in remains unclear. Hypotheses include impairment in central thirst regulation or drug therapy, which may cause an altered sensation of thirst.[8] Usually, symptoms of this syndrome are subclinical and patients are asymptomatic. However, in severe cases, mortality can occur when the polydipsia results in severe water intoxication.[9]
how quickly does hyponatremia usually occur with SSRI therapy
usually in first 2-4 weeks of therapy –> typically resolves 2 weeks after discontinuation of the SSRI
what is the incidence of hyponatremia with SSRIs
varies widely–> 0.5-30%
list symptoms of hyponatremia
N/V
malaise
stupor
coma
seizures
list symptoms of hypernatremia
irritability
stupor
coma
list symptoms of hypokalemia
arrhythmias
musclce cramps
spasm
weakness
ECGs–> U waves and flattened T waves
list symptoms of hyperkalemia
arrhythmias
muscle weakness
ECGs–> wide QRS and peaked T waves
list symptoms of hypocalcemia
tetany
seizures
QT prolongation
twitching (Chovstek sign)
spasm (Trousseau sign)
list symptoms of hypomagnesemia
tetany
torsades
kypokalemia
hypocalcemia
*an article was linked about those with SCZ having lower levels of intracellular Mg, and treatment restoring intracellular levels
list symptoms of hypermagnesemia
decreased DTRs
hypotension
lethargy
bradycardia
cardiac arrest
hypocalcemia
list symptoms of hypophosphatemia
bone loss
osetomalacia (adults) or rickets (children)
list symptoms of hyperphosphatemia
renal stones
metastatic calcifications
hypocalcemia
should you treat subclinical hypothyroidism in adults with depression
has been shown to reduce depressive symptoms
is screening for thyroid dysfunction part of the workup for dementias
yes
why should you consider thyroid screening in post partum women
anti-TPO antibody is elevated in 20% of women with post partum psychosis compared to 5-7% of all post partum women
there is an association between post partum thyroid dysfunction and depression
what is hyperthyroidism
autoimmune disorder
thyroid gland produces excess thyroid hormone
can accelerate body’s metabolism, cause unintentional weight loss and systemic symptoms and changes
what is the most common cause of hyperthyroidism
graves disease–> can be triggered by pregnancy, excess iodine intake, infections, emotional stressors, smoking
list neuropsychiatric symptoms of hyperthyroidism
hyperactivity
restlessness
anxiety
insomnia
fine tremors (due to increased beta adrenergic activity)
brisk reflexes
list ocular symptoms of hyperthyroidism
ophthalmopathy in graves disease (i.e exophthalmos, periorbital edema)
lid lag/retraction
list metabolic symptoms of hyperthyroidism
heat intolerance
sweating
weight lsos
list CV symptoms of hyperthyroidism
tachycardia
palpitations
dyspnea
arrhythmias
chest pain
hypertension
list GI symptoms of hyperthyroidism
diarrhea
increased appetite
list neuropsychiatric symptoms of hypothyroidism
hypoactivity
lethargy
fatigue
weakness
depressed mood
delayed/diminished reflexes
list metabolis symptoms of hypothyroidism
cold intolerance
decreased sweating
weight gain (lowered basal metabolic rate)
hyponatremia (decreased free water clearance)
what is the most common cause of hypothyroidism
hashimotos thyroiditis
what thyroid dysfunction may be associated with psychosis
hypothyroidism
why is vitamin B12 so important in psychiatry
major role in synthesizing and maintaining myelin in the CNS and PNS
which B vitamins have neuropsychiatric symptoms associated with htem
B1 (thiamine) and B12 (cobalamin)
what neuropsychiatric symptoms are associated with vitamin B12 deficiency
psychosis
hallucinations
mood dysfunction
irritability
dementia
catatonia
delirium
in which populations might vitamin B12 be low
vegans/vegetarians, elderly IF malnutrition (B12 found in meat + dairy products)
pernicious anemia
people on long term PPI
inhalant related disorders
what physical sign may suggest vitamin B12 deficiency
parethesias
