All right to welcome my name is Devine. This is episode 438 of the Devine

Intervention Podcast. In today's episode I'm going to be continuing the rapid

review series for the USMLA step two on step three exams, there's going to be

Series 91. Series 91. What if they give you a question about a 25 year old

male and they tell you that he presented or was brought to the

hospital by his wife because he had burned through their credit cards, spent a lot of money, and he had not been sleeping, and he had been just more talkative at home.

And they tell you that he was given an antipsychotic and another agent, but that since all of this happened he has been having polyure and polydipsia.

And then you are asked, how could this have been prevented?

Well, sounds a lot like this person has nephrogenic diabetes and sepedos from the use of lithium.

Because this person, you know, they had many deep fast symptoms sounds a lot like bipolar

disorder. When a person has bipolar disorder, they are acutely manic. When they come to the hospital,

you're going to give them a

anti-psychotic because it's going to work immediately and kind of calm them down.

But you're also going to start a boat stabilizer.

Lithium is a pretty good boat stabilizer. But remember that lithium can enter through the principal cell of the collecting duct to cause problems.

And we enters and messes of the signaling cascade of ADHD is by the

in a channel. The in a channel. Remember the principal cell of the collecting

doctor has two major channels, has the in a channel that brings in sodium,

and then he has the rompky channel that brings out potassium.

Al dostroon activates those processes.

So, our industrial mix you, bring sodium in through that inic channel and you need potassium out

through the Rompke channel. So lithium again, just going back to some college

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