P01-307 - Levothyroxine, mental confusion and attempted suicide

Abstract

ObjectivesTo illustrate, with a case report, the risk of suicide in general hospitals among inpatients with acute confusion or delirious states.MethodsThe review of a patient record who represents an instance of this risk is reported.ResultsA Brazilian farmer, with incomplete elementary education, was admitted to the General Infirmary of Adults, from the Clinical Hospital of the State University of Campinas-Brazil (Unicamp), diagnosed with a hypothyroidism mixedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. An accidental iatrogenic levothyroxine poisoning precipitated or exacerbated the confusion in this previously weakened patient, leading to psychiatric symptoms of delirium. When a bed was brought to the corridor by nurses, he considered it an ambush. Anxious, wanting to flee, he pitched himself from the 6th floor (8 meters). The fall was partly contained by a protection net. Following the episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.ConclusionsPhysicians should recognize confused states to identify and treat the underlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection and intervention in any mental disorders; assessment of suicide risks before hospital discharge.