Sunday, May 13, 2007

Happy Mother's Day!

This morning, at a little after midnight, a sweet little 27 year old mother of six-month old twins came into our ER with a complaint of abdominal pain. Further exam revealed a bit of postpartum depression, exacerbated by the fact that she has absolutely NO support system. Her husband is in the Army, and (surprise, surprise) not at home.

We gave her some Ativan, let her talk with our Mobile Crisis counselor, and gave her a few hours of free babysitting. We passed the babies around the nurses' station, fed 'em, burped 'em, changed their diapers, and put them to bed on the gurney in the "room" next to mom. She got to sleep off the Ativan. Probably the best sleep she's gotten in months.

I didn't have much contact with her, so I don't know her story. But I do know that everyone needs a little help sometimes. So we set her up with some phone numbers of resources to help her out until her husband gets back.

To all of those Moms out there that keep on doing it day after day: Happy Mother's Day! You're the best!


daedalus2u said...

Monkey Girl, postpartum depression and postpartum psychosis relate to my nitric oxide research. I will be posting a blog in the next week or so discussing exactly how they are related. It has to do with metabolic stress, and insufficient mitochondria in the liver to support gluconeogenesis to support lactation (but you don't need to be lactating to have the metabolic stress). If your patient had elevated liver enzymes, or elevated lactate, that could be it. I think there can be a rapid transition from depression to psychosis and infanticide.

What happens is that the signal for mitochondria biogenesis is NO, but when metabolic demand goes up, mitochondria make more superoxide which destroys NO blocking mitochondria biogenesis. At higher ATP production rates (and higher superoxide), oxidative phosphorylation is less efficient. If metabolic demand goes up faster than mitochondria biogenesis (as by nursing twins while being stressed maybe?), you can (in theory) reach a metabolic state where maximum ATP production capacity actually falls. I think that is what triggers postpartum psychosis and infanticide. It is the attempt to shed metabolic load to preserve maternal life under metabolic stress. An evolved "feature" observed in all mammals.

MonkeyGirl said...

She came in with a chief complaint of abdominal pain, and I know we did a hepatic function panel, and I heard all of her labs were normal. I don't recall if they did anything with her lactate level or not.

Postpartum depression is a scary thing. I'll look out for your post on the subject. Thanks for the heads up!

the queen said...

From mothers everywhere, thank you for being so kind to a momma in need, whether that be medical attention or not. You did good!