Chapter 6 146 Days after start VPA 55 63 65 66 67 68 70 71 75 77 81 83 88 89 90 Date month JAN JAN JAN JAN FEB FEB FEB FEB FEB FEB FEB FEB FEB FEB FEB day 20 28 30 31 1 2 4 5 9 11 15 17 22 23 24 MEDICATION Lithium (Li) mg 0 200 200 200 200 200 400 0 0 0 0 0 0 0 400 Li Serum levels mmol/L 0.3 Valproic Acid (VPA) mg 2500 2500 2500 2500 2500 2500 2500 2500 2500 4000 4000 4000 4000 4000 4000 VPA levels mg/L 40 43 59 66 VPA Free concentration mg/L Citalopram mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Olanzapine mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Furosemide mg 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120 Prednisone mg 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 Cyclophosphamide mg 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Lisinopril mg 0 0 0 0 0 0 0 0 0 0 0 20 20 20 20 LABORATORY BLOOD LEVELS CYP Glomerular filtration rate (GFR) ml/min/1.73m2 44 50 58 57 Creatinine (creat) umol/l 108 102 89 90 Urea mmol/l 17.2 13.1 Albumin (Alb) g/L 22.5 Hemoglobin (Hb) mmol/L 6.9 6.3 5.5 Sodium (Na) mmol/L 136 144 Potassium (K) mmol/L 3.6 3.6 C-reactive protein (CRP) mg/L mm/h 10 Total Protein g/L 1.1 Total Protein/Creatinine ratio g/mmolKr 0.42 Aspartate transaminase (AST) U/L 37 Alanine transaminase (ALT) U/L 38 Lactate dehydrogenase (LD) U/L 378 Alkaline phosphatase (ALP) U/L 81 Gamma-glutamyltransferase (yGT) U/L 32 AFFECTIVE MOOD FUNCTIONING NIMHLifeChart 3 4 4 4 4 4 4 4 4 4 4 4 4 3 3 COGNITIVE FUNCTIONING GDS 1 1 2 4 4 1 1 4 1 1 1 2 4 4 4 Delirium 1=still 2=active 1 1 1 Life events Emergency room Start amoxicilline 750mg 3dd1 for 7 days Poli nephrology: administration due to retention bladder Start prednison Flu 38.5 C Lithium stopped. Cognitive impairment due to retention bladder? Administration Psych- Med-Unit R./ lithium from 200 to 400mg CYP2C19 IM *2/*17 Reintroduction Li CYP2D6 IM *1/*4
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