At the emergency room, her laboratories and 12 L ECG were deranged.

Patient has normal Mg

2.2, High Ionized Ca 1.34, high Lithium 4.92, normal Na 143, low K 3.45, normal Crea 0.63,
normal BUN 8.4. 12-L ECG showed normal sinus rhythm and QT prolonged of 0.70 (normal 0.36-
0.46).
Hence patient was advised for admission.
She was managed under the service of Psychiatry, Cardiology, and Nephrology.
Her present psychiatric medications were put on hold.
Aggressive hydration (PNSS 120cc/hr) was done.
After which, her laboratories returned to normal values and she was restarted with the
following medication: Olanzapine 5mg/tab 1 tab once a day at bedtime, Valproic Acid
250mg/5mL 10mL BID, sinakalset 30mg/tab BID, Amlodipine 10mg/tab OD.
Currently, patient still has no appetite but is encourage to oral feed.
IV line has been removed.
There are still some crying episodes reported and patient has been oversleeping.
There are plans to transfer her to psychiatric ward after her medical clearance.

For the salient features:

 We have a case of a 58-year-old female, with a prior history of poor self-hygiene,
decrease need for sleep, grandiosity, talkativeness, flight of ideas, distractibility,
increased irritability, and agitations. Patient is allegedly abused at home and is on a
mood stabilizer drug.
 In January 2023, after a violent argument with her sibling, patient had depressed mood
and has suspectedly ingested 8 tablets of a mood stabilizer drug.
 Patient was brought to the hospital because she was no longer eating for 2 days, had
episodes of vomiting and bedwetting and was noted to have no verbal output with
tremors in the upper and lower extremity
 Vital signs were normal except for the elevated blood pressure at 130/90
 Neuro exam showed rigidity on passive flexion of upper extremity and tremors, with
clonus on both lower extremities. Other findings were unremarkable.
 On mental status exam, patient was lying on the bed, has a pixie cut hair, follows some
commands, is wearing hospital gown, has good eye contact, with euthymic affect, and
prefers not to speak. Her thought content, thought process, delusions, insight, and
judgement could not be assessed. No hallucinatory behavior noted.
 AT the ER: initial labs showed high ionized calcium, high levels of lithium, low potassium
and qt prolongation on ECG.