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A newborn is being evaluated for cyanosis. Echocardiography demonstrates apical displacement of the tricuspid valve leaflets. increased right ventricular volume, and atrialization of the right ventricle. If this neonate's condition is due to a drug side effect, the mother most likely has which of the following conditions?
O A. Gestational diabetes
O B. Schizophrenia
O C. Narcotic abuse
O D. Alcohol abuse
O E. Cocaine abuse
O F. Seizure disorder
O G. Bipolar disorder
O H. Hypothyroidism
O I. Down syndrome
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gg. Lithium effect of ebstein's anomaly
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Lithium is an anti-manic medication commonly used to treat bipolar disorder. Lithium has been linked to Ebstein's anomaly in infants exposed in utero. Ebstein's anomaly is characterized by apical displacement of the tricuspid valve leaflets, increased volume of the right ventricle, and atrialization of the right ventricle. In patients with bipolar disorder, lithium is used to treat the manic phase of the illness, while the depressive phase of the illness requires concurrent use of an antidepressant medication.
(Choice A) Gestational diabetes is associated with fetal rnacrosomia, caudal regression syndrome, hypoglycemia, hypocalcemi a and hypertrophic cardiomyopathy.
(Choice B) Neither schizophrenia nor antipsychotics have been associated with Ebstein's anomaly.
(Choice ID) Narcotic abuse may cause withdrawal symptoms in the infant upon delivery (irritability, diarrhea, vomiting) but is not associated with Ebstein's anomaly.
(Choice E) Alcohol abuse during pregnancy may lead to the fetal alcohol syndrome, characterized by: (1) midfacial anomalies (2) growth retardation, and (3) mental retardation.
Educational Objective:
Bipolar disorder is commonly treated with lithium, an anti-manic medication. Lithium has been linked to cases of Ebstein's anomaly in infants exposed in utero. Ebstein's anomaly is characterized by apical displacement of the tricuspid valve leaflets, increased right ventricular volume, and atrialization of the right ventricle.
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