IEA Hearing for difficult child at Hospital This Morning

[tessaturtle]

We have difficult child's IEA (involuntary emergency admission) hearing this morning at the hospital - we will see if he will remain there or be sent home. We are concerned they will send him home as he is being the perfect little angel inside there. We dropped off school work on Friday so that he doesn't fall behind (he is already behind enough) - they have yet to have him do it - argggh! They have educational liasons and tutors there, so there should be no reason they do not have him working on school, especially since he is "doing so well". If they would have him do the work, they could see his behavior that got him put in there...

One strange/good thing is that there blood test revealed way too high of a carbamazepine level. Strange because he just had a blood draw a couple of months ago and it was fine. Also, the dr. said it was strange because typically carbamazepine is able to metabolize/regulate itself once in your body. He was stumped.

 

[CrazyinVA]

Re the schoolwork, I can tell you from experience that not much happens in a psychiatric hospital on the weekend as far as schoolwork or sometimes even regular therapy. This used to frustrate me when one of my difficult children was admitted late in the week, because it was like they had 2 days of "skating" through with no decent evaluations or therapy until Monday morning.

Hope things go ok today..

 

[buddy]

I have no idea how Carbamazepine is metabolized... but I have shared before so those who have heard it go ahead and plug your.... eyes?

This may be totally off base but it caught us off guard so every time I hear this I share it just in case ... I am told it is not that rare and that soon enough people ar actually going to be better at dosing patients by considering this more routinely. Maybe that is a pipe dream??? But I was told that so doesn't mean it is right or anything... but the problem is for real. Mostly can make medicating tricky...but it also can be life threatening if large concentrations of medications accumulate without realizing this issue.

Q is a "poor metabolizer" for some medications based on a geneitic deficiency of certain enzymes needed to process some medications. (there are several and it all depends on which ones you have or dont have". Whether a rapid metabolizer or a poor metabolizer, in the end you can have too much medication in your system. People have died of overdoses from normally prescribed amounts. I am told depending on race... in general 6% of the population has some form of this.

So, for Q.... Prozac is on the list.... Since it does not exit the body at a normal rate, it can build over time. and eventually too much is in their bodies. I read story just a month ago about a boy who died after three days on Prozac with the same deficiency as Q has. (luckily when Q was on it our doctor suspected a problem and had only given him a small amount anyway.... and we reduced it wehn he went off in small increments too) Someone who rapidly metabolizes can break it all down too fast and then the blood amount is too high too. Or because it is broken down too fast it may result in too little in the system and then they need higher dosing to get the optimal amount. There are all kinds of inbetweens to that too. (not just is it there or is it not, and how much ... but the medication may not be broken down or transformed properly into the usable form so it is can be the body in a structure that is either harmful or not helpful at all etc....)

Of course there are testing errors that can explain things like this as well but it is always worth asking. Again, I have no idea if this is a drug that would be affected by this liver enzyme issue or not. It is easy to find out which enzymes are needed to metabolize it and then to check though. But it can be tested for. You can measure the enzymes... which does not mean you have the genetic form (for example some drugs actually can cause this issue)... and you can get the genetic tests done which I think many insurances will fight against unless there is compelling info that there could be a problem.

This article discusses one important one but in the context of a more reader friendly total explanation.

Cytochrome P450 --- Just the basics!

There is a chart as you scroll down this article, you can click on your drug of interest and see what enzymes are involved and what happens given certain problems with an enzyme....

EDIT: I just noticed this:

Is enzyme induction of CYP important?

Yes. Although most of the CYPs can be induced (the notable exception being 2D6), perhaps the most important in this regard is CYP3A4. 3A4 is the most prevalent CYP in the body, and metabolises many substrates. The most important inducers of 3A4 are antimicrobials such as rifampicin, and anticonvulsants like carbamazepine and phenytoin, but potent steroids such as dexamethasone may also induce 3A4. The long list of agents metabolised by the enzyme include opioids, benzodiazepines and local anaesthetics, as well as erythromycin, cyclosporine, haloperidol, calcium channel blockers, cisapride and pimozide. Oral contraceptives are also metabolised, and their efficacy may be impaired when an inducer such as rifampicin is taken.

Technically boring warning: (not about the drug discussed here but same issue for any that are metabolized in the liver)

Clinical Pharmacology of SSRI's
7 - Why Are CYP Enzymes Important When Considering SSRIs?

Clinical Pharmacology of SSRI's: Why Are CYP Enzymes Important When Considering SSRIs?

Since the magnitude and nature of the patient's response is concentration-dependent, the functional activity of these enzymes can make the difference between therapeutic success and failure. Such therapeutic failure may take the form of either suboptimal response or toxicity. A suboptimal response can result from the development of an inadequate concentration at the SOA due to unusually rapid clearance. Toxicity can result from the development of excessively high concentrations due to unusually slow clearance. In essence, a change in the elimination rate (ie, clearance) of a drug is the mirror image of a change in its dosing rate (Figure 7.5). Parenthetically, clearance is the amount of drug cleared per unit of time. The reason is the concentration of drug achieved in the body is directly proportional to the dosing rate and is inversely proportional to its elimination rate.
This inverse relationship is illustrated in Figure 7.5. Due to this relationship, a change in the functional activity of the enzymes mediating the biotransformation of a drug necessary for its eventual elimination typically produces an effect the opposite of what would occur with a change in the dosing rate. For example, a decrease in functional activity in the CYP enzymes will lead to a decrease in drug clearance and an increase in drug accumulation (ie, the same net effect as will occur with a dose increase). Conversely, an increase in functional activity of the enzyme would typically result in a decrease in drug accumulation (ie, a net effect similar to a dose decrease).

Just a thought....

 

[StressedM0mma]

I hope that the psychiatric hospital will listen to you and realize that he needs to stay there longer. I know how hard it is to get people to listen. Esp. when they think your child is "doing so well". I do not know if you son is like my difficult child, but she is an amazing actor. She knows just what to say and do. Hugs. Hope things work out they way you would like them too.