Seizures: Low P, Low D and Lots of THC
Dustin had a history of seizures that were always mild and only happened at night. He took his medication faithfully. But a couple of months ago he had a bad one.
The emergency room workup showed that his phosphorous was critically low. They replenished it intravenously and his level normalized and stayed up.
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My reading when I saw him in followup suggested that hypophosphatemia is sometimes transient without explanation, but sometimes related to vitamin D deficiency.
I prescribed vitamin D, which is something I rarely do because I’m very skeptical of D supplementation. I describe D levels as a lab test looking for a disease. Here in northern Maine all mental health professionals tell her patients to take vitamin D for seasonal affective disorder with no scientific backup.
So Dustin got his prescription for vitamin D and his phosphorus level stayed OK for a while but next thing I knew he was in the emergency room again with a seizure and a low phosphorus. I added a vitamin D level to the serum already in the lab and it had not budged at all since I started him on replacement.
I knew Dustin smoked a lot of marijuana and the emergency room pointed out the same thing. I realized that I should have been more aggressive with my dosing of his vitamin D but I just had a funny feeling that maybe there was a connection between marijuana use and low phosphorus.
I asked my esteemed colleague, Dr. Google. He instantly brought an article to my attention about a probable connection between marijuana use and low phosphorus.
So I cranked up Dustin’s vitamin D dose and gave him a printout of the article. “You might want to cut back on your marijuana use”, I suggested.
I guess I’m hedging my bets here between the low D and the high THC, and I’m open to other possibilities. The big message here, for what my CEO called a “late career physician”, is (and I’ve said it before): May I never lose my curiosity. (Although in the linked post, it seemed like CBD oil did something good – always ask, always wonder, always question…)