Lauren took lithium for her bipolar disorder and went to her physician because s
ID: 3518358 • Letter: L
Question
Lauren took lithium for her bipolar disorder and went to her physician because she felt dizzy upon standing. He told her that she was dehydrated, and urged her to increase her water intake. Lauren also took probenecid for her gout and hydrochlorothiazide for her hypertension. A month later she experienced muscle weakness, and upon examination was found to have a normal eGFR. However, her blood results revealed that she had moderate hypokalemia. Her urine tested negative for glucose. Her physician told her to stop taking the hydrochlorothiazide, and instead placed her on a different diuretic drug.
Some of the new terms and concepts you will encounter include:
Countercurrent multiplication and countercurrent exchange
Diabetes insipidus, renal reabsorption and secretion
Glomerular filtration rate, renal plasma clearance, and diuretics
Lauren was on lithium for her bipolar disorder and experienced dizziness upon standing.
What condition likely caused Lauren's dizziness, and how is that related to dehydration?
What treatment did the physician advise for this condition?
Lauren took probenecid to treat her gout.
How does this drug act on the kidneys to help treat gout?
How might this drug act on the kidneys to affect Lauren's response to certain antibiotics?
Lauren's blood test results indicated that she has a normal eGFR.
What is an eGFR and how is it obtained?
What is the significance of an eGFR measurement?
Lauren's urine tested negative for glucose.
What processes determine the presence of glucose in the urine?
What would be the significance of a positive urine test for glucose?
Lauren experienced muscle weakness and her lab test revealed that she had hypokalemia. Her physician took her off hydrochlorothiazide and prescribed a different medicine.
What is hypokalemia, and how might it have been produced in Lauren?
What other symptoms might her hypokalemia produce?
After Lauren experienced hypokalemia, her physician discontinued her hydrochlorothiazide and prescribed a different medicine.
How does hydrochlorothiazide work as a diuretic, and how might it produce hypokalemia?
What other type of diuretic might the physician prescribe, and how would it help Lauren's hypertension and hypokalemia?
Explanation / Answer
Lithium affects the way sodium entry in and out of the cell, thus affects fluid management. Sodium affects how water moves in the body. Hence dehydration occurs. Lithium also causes overheating to body leading to dehydration if enough fluids are not taken. This condition leads to dizziness.
Physician advised her to take water intake to avoid further complications.
Probenecid interferes with kidneys organic ion transporter which reabsorbs uric acid from urine. Probenecid binds with organic ion transporter and prevents reabsorption of Uric acid, thus lowers its level treating gout.
Probenecid increases the effect of certain antibiotics such as penicillin, ampicillin by binding to them and preventing them to pass from body.
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