06-14-2010, 05:14 PM
A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3
weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and
valproic acid. Physical examination shows no abnormalities except for dried blood in the nares.
Mental status examination shows an anxious mood and slight motor restlessness. Serum studies
show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6“1.2), and valproic acid level of
77 μg/mL (therapeutic range=40“100). Which of the following is the most appropriate next step in
management?
A
) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B
) Measurement of serum bupropion level
C
) Platelet count
D
) Discontinuation of lithium carbonate therapy
E
) Discontinuation of valproic acid therapy
weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and
valproic acid. Physical examination shows no abnormalities except for dried blood in the nares.
Mental status examination shows an anxious mood and slight motor restlessness. Serum studies
show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6“1.2), and valproic acid level of
77 μg/mL (therapeutic range=40“100). Which of the following is the most appropriate next step in
management?
A
) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B
) Measurement of serum bupropion level
C
) Platelet count
D
) Discontinuation of lithium carbonate therapy
E
) Discontinuation of valproic acid therapy