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• W4378070852 abstract "There is little consensus on the use of vitamins and minerals in patients receiving treatment for serious mental illness (SMI) so there is reasonable concern about how these products may impact the health of individuals with SMI. And although we specifically aim to explain the approach taken, and potential risks involved with, the prescribed supervised magnesium administration for clozapine induced constipation in a renally impaired older adult diagnosed with Bipolar-1 disorder, we describe extrapolated concerns about self-treatment using over the counter (OTC) vitamin and mineral supplementation as well in vulnerable individuals, including those diagnosed with SMI. Here we present a case of an elderly 72-year-old-female patient diagnosed with Bipolar-I disorder who was admitted to a State-operated psychiatric hospital for psychiatric stabilization in 2016. The patient's seven-year hospital course required initiation of clozapine prescribed concomitantly with other anticholinergic medications, which resulted in significant constipation requiring treatment intervention that included daily scheduled docusate 100 mg, lactulose 20 gm/30 mL, sennosides 8.6 mg and as needed (PRN) doses of magnesium (Mg) which included Mg citrate 8.6 g (administered as one-half of a commercially available 300 mL bottle containing 1.745 g/30 mL) and Mg hydroxide 2.4 g (administered as one 2400 mg/30 mL dose cup). If both PRN doses of Mg were to be administered, the cumulative dose would be 11 g (205 mEq) of Mg. As a result of a national recall and subsequent shortage, all patients prescribed magnesium citrate (MgCit) had to be evaluated for therapeutic substitution with alternative magnesium formulations. And although considered to be “exceedingly safe” by the medical staff within the facility of record, the pharmacists involved in the therapeutic interchange consulted on risk of hypermagnesemia for patients with compromised renal function. As a result of this review, the patient's renal function was reported to be reduced with a creatinine clearance (CrCL) of 23.20 mL/min. Further noted during clinical evaluation, was the absence of baseline or subsequent magnesium serum concentrations. Upon discharge, which occurred 4 months after the recall, the patient's prescriber obtained a Mg serum concentration, which was reported to be at the upper limit of normal at 2.6 mg/dL (range 1.7–2.7 mg/dL) despite not having been administered any Mg within the previous 24 months, even with the standing PRN order to be given if clinically indicated. This critical lab value also served to inform the next care provider that an alternative treatment intervention for clozapine constipation would be warranted. To our knowledge, this is the first report of an individual diagnosed with SMI prescribed a significant dose of Mg for the treatment of antipsychotic induced constipation who also had silent and unrecognized renal compromise. And while Mg is considered by most clinicians to be relatively safe for general use, there are reports of serious and sometimes fatal toxicity associated with excessive serum Mg concentrations. This case report also serves as a reminder that determining organ function prior to initiating any pharmacologic treatment should be a routine part of prescribing. Additionally, this publication should serve as a clinical reminder that when treating individuals who may lack insight into their mental and physical health, whether hospitalized or in the community, it is important to educate on the realistic expectations of benefits, and potential risks of, self-treatment with OTC supplemental vitamins and minerals, regardless the reason for use." @default.
• W4378070852 created "2023-05-25" @default.
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• W4378070852 date "2023-06-01" @default.
• W4378070852 modified "2023-09-23" @default.
• W4378070852 title "Exploring the risk of magnesium use for antipsychotic induced constipation: A case study for consideration" @default.
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• W4378070852 doi "https://doi.org/10.1016/j.psycr.2023.100132" @default.
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