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Hypokalemia: one of those is because of poor nutrition and another is eating disorders. These bulimic women – and believe me, it tends to be a disease of women – will vomit, will make themselves vomit and then they will get hypokalemic. Also, here’s a trivia question. There’s also a certain type of food that, if you eat a lot of, will cause hypokalemia. Does anyone know what that is? Licorice. Yeah, certain types of black licorice will cause hypokalemia. Every once in awhile you will see this case report and you’ve got this poor, young bulimic who loves to binge on licorice. She is just eating strands and strands of black licorice and then throwing it up, and her potassium is in the basement as a result of that.
EKG abnormalities: thioridazine can cause quinidine-like effects, such as prolonged TP and CR intervals. That’s important to know. Mellaril, or thioridazine, that is the least heart-healthy of your antipsychotics probably. Lithium can cause T-wave flattening or inversion. Looks like hypokalemia. TCA overdose, classically QRS widening and anorexia can result in bradycardia or other arrhythmias. Kind of another neat point is sometimes what you will see on psychiatric units, a common cause of bradycardia – mild bradycardia – is nicotine withdrawal. Now hospitals are all non-smoking, including psychiatric units and you’ll see these people – they’ll have a slow heart rate sometimes. Most substances, when you withdraw, you get tachycardic, as you know. Nicotine is the reverse of this. It’s kind of paradoxical. The heart rate can slow down.
There is one where you’ve got to get an EKG. Lithium, no question. You want an EKG. There were a few tragic deaths with one of the TCAs, desipramine I believe. There were a few kids who died unfortunately, in a relatively short period of time, because they were put on desipramine. There were like six kids cialis professional and in a short period of time three of them died and three of them, I guess, lived. But they had fatal arrhythmias from desipramine. So in pediatric populations we like to get EKG’s. But in your young, healthy adult – let’s say somebody comes in for pain – “Hey doc, I’ve got headache.” You are going to put them on Elavil, amitriptyline – which I’m assuming is still used by neurologists for pain. Probably not. It’s always nice to get an EKG but I don’t think most people would say this is mandatory to get an EKG. Anybody with heart block is at risk for having a TCA, so it’s nice to have an EKG but I don’t think it’s standard of care like it is with lithium.
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