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Case Study Behavior Changes and the Bladder

Anisette Doe, a 28-year old woman, went to the emergency department with abdominal bloating and inability to void her bladder; she had been unable to urinate for 16 hours. A urinary catheter was inserted and 2.5 L of urine was withdrawn. Subsequent testing revealed no calculi or masses in the bladder, urethra, ureters, or kidneys. Ms. Doe's medical records indicated that she was being treated with clozapine for paranoid schizophrenia. She reported no significant side effects as a result of this treatment. For 2 days prior to admission to the hospital, Ms. Doe complained of a cold and was taking diphenhydramine (Benadryl)

50 mg every 6 to 8 hours. What is a possible explanation for the sudden onset of her inability to void her bladder?

The case in context: Clozapine is a newer antipsy-chotic that can, like other agents in its class, produce antimuscarinic side effects. Although Ms. Doe had not complained of anticholinergic effects prior to beginning treatment with a moderate dose of diphenhydramine, it is likely that the additive anti-cholinergic effects of clozapine and diphenhy-dramine resulted in urinary retention.

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