Volume 7 Issue 12 December, 2017
Consultation Liaison Psychiatry : Biochemistry
Kumuda, a high school student, studying in Class 8 at St.Xavier’s in Mangalore was found to be very quiet in the classroom nowadays. A cheerful girl, who studied in the same school from her kindergarten years, was found to be disinterested in most of the indoor and outdoor classroom activities. Her class teacher Mrs. Shanta was the first one to notice this. When she tried to speak to kumuda, there was no response from the child. The teacher was worried as it was so unlike kumuda. The teacher called her mother and asked her to meet in person. That is when the teacher came to know about kumuda’s father’s death.
Kumuda’s mother told the teacher that she and her father both shared equal responsibilities to bring up kumuda as theirs was a close knit nuclear family. Despite the sharing of equal responsibilities, kumuda always felt closer to her father and she would always open up to him about any of her new found secrets. After his death, though her mother took extra care of her, kumuda was slowly losing herself and becoming more of a quiet girl and rarely one could see a silent rage in her that she could not control. At such times she would either hurt herself or hurt anyone in her vicinity. Earlier she was a bubbly girl and loved all animals near her house. But once after her father’s death, she had stoned at a dog continuously until it started bleeding and cried in pain. Her mother saw this and had gotten her home all the way scolding her for hurting the poor dog. Kumuda was not bothered. She was apathetic.
After listening to this Mrs. Shanta suggested Mrs Rao to take kumuda to a good counsellor, so that she could move on and get to be her usual self. Mrs. Rao took her to Dr. Ballal who was a well known psychiatrist. He said that kumuda is having bipolar disorder and started her on drug valproate as well as few counselling sessions in between.
After starting the drug kumuda slowly improved and got back to her usual self. After about 3 months or so kumuda started having mild lower abdominal pain usually on the right side, nausea and vomiting. After a few days she noticed that she was passing high coloured urine and her mother noticed that she had yellowish discoloration of her eyes. Immediately they went to the physician where on doing an LFT, kumuda’s liver enzymes AST and ALT were seen to be elevated.
ALT and AST are transaminases, secreted by the hepatic parenchyma, are liver specific enzymes. The normal levels vary between 5-35 IU/L. Both get elevated by about 4 to 5 times the normal. The drug Valproic acid is known to induce hepatitis.
Though we study biochemistry as a subject in the first year of MBBS, we may not realize its significance until we start clinical postings. As you saw in the above case, LFT is an important test done to detect the drug induced hepatitis. All the organ function tests are similarly very important to confirm the diagnosis made by a physician. These analytes are important in all the medical and surgical departments to diagnose variety of cases across all specialities. Biochemistry helps us to study about various analytes, their metabolism and functions both in health and disease.
In the above case as the psychiatrist had an idea about the drug as well as the necessary biochemical investigations, kumuda could get the treatment at the earliest and she could recover sooner.
As Louis Pasteur said that “Without laboratories, men of science are soldiers without arms”. If medical students fail to learn biochemistry, then their state will be the same as soldiers without arms.
Dr. Kusuma, Associate Professor, M S Ramaiah Medical College, Bengaluru
