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14. Consult Liaison Psychiatry > Electrolyte Disturbances + Thyroid Disease + Vitamin B12 deficiency > Flashcards

Electrolyte Disturbances + Thyroid Disease + Vitamin B12 deficiency Flashcards

1
Q

what psychiatric medication can result in hypercalcemia and hyperparathyroidism

A

long term lithium treatment

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2
Q

what are the symptoms of hypercalcemia

A

“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

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3
Q

what is the prevalence of hypercalcemia and hyperparathyroidism in those treated with lithium

A

up to 10%

even higher in geriatric population

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4
Q

how does lithium cause hypercalcemia and hyperparathyroidism

A

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

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5
Q

what is the definitive treatment for lithium induced hypercalcemia and hyperparathyroidism

A

stopping lithium

(otherwise, if its not due to lithium, parathyroidectony is the only treatment)

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6
Q

what symptoms can be associated with acute-onset hyponatremia

A

delirium

acute behavioural changes

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7
Q

how do most medications that can cause hyponatremia do this?

A

most trigger inappropriate ADH secretion

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8
Q

list some etiologies of hyponatremia

A

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)

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9
Q

what three factors characterize SIADH

A

Excessive free water retention
Euvolemic hyponatremia with continued urinary sodium excretion
Urine osmolality > serum osmolality

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10
Q

what is PIP syndrome

A

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]

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11
Q

how quickly does hyponatremia usually occur with SSRI therapy

A

usually in first 2-4 weeks of therapy –> typically resolves 2 weeks after discontinuation of the SSRI

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12
Q

what is the incidence of hyponatremia with SSRIs

A

varies widely–> 0.5-30%

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13
Q

list symptoms of hyponatremia

A

N/V

malaise

stupor

coma

seizures

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14
Q

list symptoms of hypernatremia

A

irritability

stupor

coma

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15
Q

list symptoms of hypokalemia

A

arrhythmias

musclce cramps

spasm

weakness

ECGs–> U waves and flattened T waves

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16
Q

list symptoms of hyperkalemia

A

arrhythmias

muscle weakness

ECGs–> wide QRS and peaked T waves

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17
Q

list symptoms of hypocalcemia

A

tetany

seizures

QT prolongation

twitching (Chovstek sign)

spasm (Trousseau sign)

18
Q

list symptoms of hypomagnesemia

A

tetany

torsades

kypokalemia

hypocalcemia

*an article was linked about those with SCZ having lower levels of intracellular Mg, and treatment restoring intracellular levels

19
Q

list symptoms of hypermagnesemia

A

decreased DTRs

hypotension

lethargy

bradycardia

cardiac arrest

hypocalcemia

20
Q

list symptoms of hypophosphatemia

A

bone loss

osetomalacia (adults) or rickets (children)

21
Q

list symptoms of hyperphosphatemia

A

renal stones

metastatic calcifications

hypocalcemia

22
Q

should you treat subclinical hypothyroidism in adults with depression

A

has been shown to reduce depressive symptoms

23
Q

is screening for thyroid dysfunction part of the workup for dementias

A

yes

24
Q

why should you consider thyroid screening in post partum women

A

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

25
Q

what is hyperthyroidism

A

autoimmune disorder

thyroid gland produces excess thyroid hormone

can accelerate body’s metabolism, cause unintentional weight loss and systemic symptoms and changes

26
Q

what is the most common cause of hyperthyroidism

A

graves disease–> can be triggered by pregnancy, excess iodine intake, infections, emotional stressors, smoking

27
Q

list neuropsychiatric symptoms of hyperthyroidism

A

hyperactivity

restlessness

anxiety

insomnia

fine tremors (due to increased beta adrenergic activity)

brisk reflexes

28
Q

list ocular symptoms of hyperthyroidism

A

ophthalmopathy in graves disease (i.e exophthalmos, periorbital edema)

lid lag/retraction

29
Q

list metabolic symptoms of hyperthyroidism

A

heat intolerance

sweating

weight lsos

30
Q

list CV symptoms of hyperthyroidism

A

tachycardia

palpitations

dyspnea

arrhythmias

chest pain

hypertension

31
Q

list GI symptoms of hyperthyroidism

A

diarrhea

increased appetite

32
Q

list neuropsychiatric symptoms of hypothyroidism

A

hypoactivity

lethargy

fatigue

weakness

depressed mood

delayed/diminished reflexes

33
Q

list metabolis symptoms of hypothyroidism

A

cold intolerance

decreased sweating

weight gain (lowered basal metabolic rate)

hyponatremia (decreased free water clearance)

34
Q

what is the most common cause of hypothyroidism

A

hashimotos thyroiditis

35
Q

what thyroid dysfunction may be associated with psychosis

A

hypothyroidism

36
Q

why is vitamin B12 so important in psychiatry

A

major role in synthesizing and maintaining myelin in the CNS and PNS

37
Q

which B vitamins have neuropsychiatric symptoms associated with htem

A

B1 (thiamine) and B12 (cobalamin)

38
Q

what neuropsychiatric symptoms are associated with vitamin B12 deficiency

A

psychosis

hallucinations

mood dysfunction

irritability

dementia

catatonia

delirium

39
Q

in which populations might vitamin B12 be low

A

vegans/vegetarians, elderly IF malnutrition (B12 found in meat + dairy products)

pernicious anemia

people on long term PPI

inhalant related disorders

40
Q

what physical sign may suggest vitamin B12 deficiency

A

parethesias

14. Consult Liaison Psychiatry (7 decks)

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