A 54-year-old female presented to the gastroenterology service through the emergency department (ED) with abdominal pain &
diarrhea for 3 weeks. Past medical history was signiicant for bipolar disorder, Schizophrenia and chronic obstructive pulmonary disease.
She was on regular daily Lithium (450 mg/day), clozapine (337.5 mg/day), oxybutynin (10 mg/day), valproic acid (1000 mg/day), and
tiotropium bromide (18 mc/day) inhaler. Here were no recent changes made to drug dosages and no history of previous abdominal surgeries.
he abdominal pain started suddenly and gradually progressed. It was more in the right lower quadrant, dull in character and intermittent
in nature. It was non-radiating and associated with abdominal distention and bloating. He diarrhea was watery, small in amount and
occurred up to eight times per day, there was no blood or mucous seen. Here were no further gastrointestinal symptoms. History was negative
for travel, infectious contacts or antibiotic use. Review of systems was negative apart from chronic fatigue and weakness. Socially, the patient
resided at the Regional Mental Hospital (RMH) due to her severe psychiatric disability.
Last date updated on July, 2014