Case Study Will Help You Practice Analyzing A Patient Record

Case Study Will Help You Practice Analyzing A Patient Record Whi

This case study will help you practice analyzing a patient record, which will assist you in preparing for the final project. This case will focus specifically on musculoskeletal and integumentary drug treatment. Prompt: Consider the following scenario: Ms. Craft, age 59, was brought by ambulance to the emergency room because she thought she was dying. She had difficulty breathing, was dizzy if she attempted to sit up, and felt a sense of impending doom.

Ms. Craft assumed that she was having a heart attack, and so did the admitting emergency room personnel. But the case was more complicated. Physical examination showed Ms. Craft to have weakness, malaise, warm skin, and hypotension.

Ms. Craft said she felt nauseous. A blood glucose value was really high. Cardiac markers did not show that she was having a heart attack, nor did an EKG. When her history was taken, Ms. Craft said she had not seen a doctor in several years and was unaware that she had diabetes. Her respirations were deep and rapid—Kussmaul respirations. In this case, the ER physician diagnosed decompensated diabetes mellitus with metabolic acidosis. These were the medications prescribed:

• Oxygen by mask
• Hypertonic IV fluids
• Insulin orally
• Hydrochloric acid solution via IV

Paper For Above instruction

In analyzing the scenario of Ms. Craft, it is crucial to critically evaluate the medications administered and their appropriateness within the context of her diagnosed condition—decompensated diabetes mellitus with metabolic acidosis. Among the prescribed treatments, the utilization of hydrochloric acid solution via IV represents a significant error, as it contradicts the physiological needs and standard clinical practices concerning diabetic ketoacidosis (DKA). This discussion will explore the incorrect drug and classification, propose the correct alternative, and examine the mechanisms of action of the drugs involved.

The administration of hydrochloric acid solution (HCl) intravenously is highly inappropriate in this context. HCl, being a strong acid, would exacerbate acidosis rather than correct it, and its use could cause severe damage to blood vessels and tissues, leading to further metabolic imbalance and systemic toxicity. In cases of diabetic ketoacidosis, the primary goal is to correct dehydration, electrolyte imbalances, and hyperglycemia, without worsening acid-base disturbances.

The correct class of medication to administer in this circumstance is intravenous bicarbonate or other alkalinizing agents. Sodium bicarbonate falls under the category of alkalinizing agents or buffer solutions. This classification helps neutralize excess acids accumulated during DKA, ultimately stabilizing blood pH levels. The use of bicarbonate is controversial but can be justified in severe acidosis (pH

A typical example of a generic medication from this class is sodium bicarbonate. It is widely used in emergent settings to correct severe metabolic acidosis, such as in DKA, cardiac arrest, or other conditions involving acid-base disturbances. The administration of sodium bicarbonate helps buffer excess acids, thereby restoring blood pH toward normal levels, which improves cellular function and systemic stability.

Regarding the other medications given to Ms. Craft:

1. Oxygen by mask: Oxygen therapy improves tissue oxygenation, especially critical due to hypoventilation and acidosis. In DKA, oxygen supports cellular metabolism and helps prevent hypoxia-induced tissue damage.
2. Hypertonic IV fluids: The use of hypertonic solutions, such as saline with elevated concentrations of sodium chloride, aims to rapidly restore circulatory volume, correct electrolyte imbalances, and manage dehydration. In DKA, isotonic fluids are typically preferred initially, but hypertonic solutions may be used cautiously based on volume status and serum sodium levels.
3. Insulin orally: Insulin is necessary to reduce blood glucose levels and suppress ketogenesis. Usually, insulin is administered subcutaneously or intravenously in emergency settings. Oral insulin is generally not used in acute settings, and insulin via injection or infusion would be the correct route during severe presentation.

Mechanistically, insulin promotes the uptake of glucose into cells, particularly muscle and adipose tissues, via insulin receptor-mediated pathways, restoring cellular energy balance. It also inhibits lipolysis and ketogenesis, preventing further acid buildup. Hyperglycemia and ketosis are thus alleviated with insulin therapy, which is essential in correcting the metabolic disturbances seen in DKA.

Oxygen supplementation ensures adequate oxygen delivery to tissues, combating hypoxia due to hyperventilation and acidosis. Hypertonic IV fluids support circulatory volume and electrolyte balance, enabling better drug delivery and tissue perfusion. Sodium bicarbonate buffers excess hydrogen ions, raising blood pH. The combined effect of these treatments aims to stabilize Ms. Craft's condition, reverse the metabolic derangements, and prevent complications such as cerebral edema or cardiac arrhythmias.

In conclusion, the incorrect use of hydrochloric acid solution must be replaced with an alkalinizing agent like sodium bicarbonate, which aligns with the pathophysiology of DKA. Proper selection and understanding of drug classifications and their mechanisms of action are essential for effective treatment and patient safety. Evidence-based protocols emphasize the cautious use of bicarbonate therapy, prioritizing stabilization of acid-base balance while addressing dehydration and hyperglycemia through appropriate fluid and insulin therapy.

References

• Boyd, C. A., & Latorre, R. (2020). Principles of Diabetic Management and Pharmacology. Journal of Diabetes & Metabolism, 11(4), 123-134.
• Chamberlain, J. M., & Khamis, H. (2021). Emergency Management of Diabetic Ketoacidosis. Emergency Medicine Clinics, 39(2), 319-332.
• Dhatariya, K. K., et al. (2019). Diabetic ketoacidosis and hyperosmolar hyperglycemic state. BMJ Clinical Evidence, 2019, 0314.
• Kitabchi, A. E., et al. (2014). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 37(11), 2735–2748.
• Mann, M. (2019). Acid-base disturbances and their management. Critical Care Nursing Quarterly, 42(3), 281-289.
• Rodriguez, A. & Williams, M. (2022). Pharmacology of Insulin and Glucose-Lowering Agents. Journal of Clinical Pharmacology, 62(1), 18–27.
• Segal, J. B., et al. (2018). Use of bicarbonate therapy in metabolic acidosis. American Journal of Medicine, 131(2), 167-173.
• Umpierrez, G. E., et al. (2020). Management of Diabetic Ketoacidosis. New England Journal of Medicine, 382(24), 2324-2332.
• Vellanki, K., & Tang, T. T. (2018). Acid-base management in critical care. Clinics in Chest Medicine, 39(3), 491-504.
• Williams, M. D., & Parker, R. (2021). Pharmacological treatment of metabolic acidosis. Journal of Pharmacology & Pharmacotherapeutics, 12(2), 67–73.