Psych Labs

Question 1

Which elements of a CMP should be considered during valproate therapy?

Answer 1

AST, ALT

Normal range 0 to 40 u/L

Question 2

Elevated GGT is found in…

Answer 2

Cholestasis and high alcohol use. Normal range 0 to 30

Question 3

Alkaline phosphatase ALP is elevated in

Answer 3

Gallbladder disease, liver disease, bone injury or rapid bone growth

Normal range 30 to 120 IU/L

Question 4

AST and ALT are normal, but ALP is elevated. Adding what lab can help rule out liver as source of elevated ALP?

Answer 4

GGT

Question 5

Elevated ALP normal in

Answer 5

Teenagers with rapid bone growth, pregnant women

Question 6

Which deadly syndrome has an elevated creatine kinase CK?

Answer 6

Neuroleptic malignant syndrome secondary to antipsychotic medication

Question 7

CK-MB is specifically elevated in

Answer 7

Cardiac patients (myositis, myocardial infarction)

Question 8

Creatine kinase measures …

What is the normal range of CK?

Answer 8

Muscle injury. Found in heart, brain, skeletal muscle

< 0 to 139 u/L

Question 9

Which two elements of the BMP should be focused on during lithium treatment?

Answer 9

BUN and Creatinine:

1. Assess kidney fnx
2. ⬆️ in impaired kidney fnx

BUN: 8-18 mg/dL
Also elevated in significant dehydration

CR: 0.64-1.2
Varies by age, gender, and ethnicity
More sensitive and specific indicator of kidney disease than BUN

Question 10

What is the best measurement of kidney function?

Answer 10

Glomerular filtration rate GFR
e.g. elderly patient with normal creatinine but 30% reduced GFR due to reduced muscle mass

Normal: > 90 mL/min

Most psych meds, generally no dose adjustment or contraindications as long as GFR > 60 mL/min

Question 11

What happens to lithium levels during:

1. Dehydration
2. Sodium intake
3. Sodium intake

Answer 11

1. Dehydration ⬇️💧—> ⬇️Li excretion—> ⬆️ Li level
2. ⬆️ Na+ intake —> ⬆️ 💧 —> ⬆️ Li
   excretion —> ⬇️ Li level
3. ⬇️ Na+ intake —> ⬇️ 💧—> ⬇️ Li excretion —> ⬆️ Li level

Question 12

Lithium level for acute treatment versus maintenance

Lithium toxicity range

Symptoms of lithium toxicity

Answer 12

Acute management 0.8-1.2 mmol/L
Maintenance 0.6-1.0

Lithium toxicity may begin at 1.5 though typically occurs > 2

Symptoms include lethargy, fatigue, clumsiness, weakness, muscle cramping, nausea, vomiting, severe tremor, blurred vision, confusion