phantasmagoric
New Member
- Joined
- Jan 29, 2025
- Messages
- 2
- Reaction score
- 0
Hello all,
I am currently a PGY1 at a psychiatry program. Over the last few months, I have accumulated a few questions particularly when it comes to inpatient/CL psychiatry.
I have brought up these topics in some capacity with my attendings, but would still appreciate further/alternative insights from this forum.
Thank you very much in advance!
1) In the inpatient/CL settings, how might we conceptualize when we might want to order labs for Vitamin B12, Vitamin D, HIV, Syphilis etc.? Can we generalize it as when the patient has a mental status change and/or encephalopathic presentation, in addition to having risk factors (e.g.vitamins when they may be mal-nourished)?
2a) How do you approach the decision to stop or continue medications inpatient/CL setting if a patient presents with an overdose? If we believe that the medication would be at a supra-therapeutic level based on the HPI, do we stop the offending medication or also other hepatically metabolized medications in order to give it "hepatic washout/vacation"? Would this apply if the patient overdosed on something that is not a psychotropic e.g. Tylenol? Do you refer to LFTs at all to inform this decision at all?
2b) In terms of restarting, I've learned that if we want to continue the medication that the patient ODed on, we would give it 2-3 half-lives of the overdosed medication before restarting it and other psychiatric medications. If we didn't want to continue the medication, we would restart the other psychiatric medications after waiting for 5 half-lives of the overdose med. Is this consistent with your practice and do you check LFTs to see downtrend before restarting psych meds?
I am currently a PGY1 at a psychiatry program. Over the last few months, I have accumulated a few questions particularly when it comes to inpatient/CL psychiatry.
I have brought up these topics in some capacity with my attendings, but would still appreciate further/alternative insights from this forum.
Thank you very much in advance!
1) In the inpatient/CL settings, how might we conceptualize when we might want to order labs for Vitamin B12, Vitamin D, HIV, Syphilis etc.? Can we generalize it as when the patient has a mental status change and/or encephalopathic presentation, in addition to having risk factors (e.g.vitamins when they may be mal-nourished)?
2a) How do you approach the decision to stop or continue medications inpatient/CL setting if a patient presents with an overdose? If we believe that the medication would be at a supra-therapeutic level based on the HPI, do we stop the offending medication or also other hepatically metabolized medications in order to give it "hepatic washout/vacation"? Would this apply if the patient overdosed on something that is not a psychotropic e.g. Tylenol? Do you refer to LFTs at all to inform this decision at all?
2b) In terms of restarting, I've learned that if we want to continue the medication that the patient ODed on, we would give it 2-3 half-lives of the overdosed medication before restarting it and other psychiatric medications. If we didn't want to continue the medication, we would restart the other psychiatric medications after waiting for 5 half-lives of the overdose med. Is this consistent with your practice and do you check LFTs to see downtrend before restarting psych meds?