During an outpatient psychiatric evaluation, a physician is planning the long-term management of a 35-year-old male patient with bipolar I disorder. The patient has been unmedicated for over a year but recently experienced a severe manic episode that disrupted his employment. He is now stabilized and agrees to begin maintenance pharmacotherapy with lithium carbonate. Prior to writing the prescription, which of the following baseline investigations must be ordered? (Select all that apply)
- Serum creatinineCevap
- Thyroid-stimulating hormoneCevap
- CFasting lipid panel
- DProthrombin time and activated partial thromboplastin time
- ENoncontrast computed tomography of the head
Cevap
The necessary baseline laboratory tests are serum creatinine and thyroid-stimulating hormone.
Lithium is a narrow therapeutic index medication used for mood stabilization. It is excreted almost entirely by the kidneys and can cause nephrogenic diabetes insipidus as well as chronic tubulointerstitial nephropathy. Therefore, baseline renal function (serum creatinine) must be established. Additionally, lithium frequently induces hypothyroidism or goiter. Obtaining a baseline thyroid-stimulating hormone (TSH) level is essential to safely monitor the patient over time and distinguish drug-induced thyroid dysfunction from other causes.
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Anahtar Kavram
Before initiating lithium therapy, baseline laboratory monitoring must include renal function (serum creatinine/BUN) and thyroid function (TSH). A pregnancy test is also required in females of childbearing age.