Case for practice
Ms. X, age 41, has a history of bipolar disorder and presents with extreme sleepiness, constipation with mild abdominal cramping, occasional dizziness, and “palpitations.” Ms. X seems to have trouble describing her symptoms and reports that they have been worsening over 4 to 6 days. She is worried because she is making mistakes at work and repeatedly misunderstanding directions.
Ms. X has a family history of hyperlipidemia, heart disease, and diabetes, and she has been employing a healthy diet, exercise, and use of supplements for cardiovascular health since her early 20s. Her medication regimen includes lithium, 600 mg, twice a day, quetiapine, 1,200 mg/d, a multivitamin and mineral tablet once a day, a brand name garlic supplement (garlic powder, 300 mg), and fish oil, 2 g/d, at bedtime. Lithium levels consistently have been 0.8 to 0.9 mEq/L for the last 3 years
Ms. X describes no changes in her diet or prescription medications but mentions that the brand name garlic supplement she takes was out of stock early last week, so she bought another brand of garlic supplement, consisting of oil capsules. Ms. X says, “I made sure the dose was exactly the same, since you told me not to change doses without checking you first.
You review the bottle she brought with her and see that it contains garlic oil with “allicin equivalent to 300 mg of garlic powder” and 60 mg of vitamin C with rose hips, vitamin E, 20 IU, vitamin A, 2,200 IU, and piperine , 20 mg.