A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. Patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Assessment in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L.
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
Sample free essay – Answer
Case Study Analysis
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Case Study Analysis
From the case study, the 27-year old presented various symptoms that lead to the establishment and determination of an opiate abuse. To begin with, the patient was found unresponsive which means that they could have blacked out after the consumption of opioids considering that he has a history of substance abuse. After receiving naloxone, the patient managed to become responsive, this means that the effects of opioids was blocked. Naloxone is mainly used for the patients with drug and substance abuse issues as it helps in managing their body reactions against the respective opioids that have been consumed into the body. The opioids are associated with a reduced rate of breathing and in the event that an individual overdoses the drugs, they may have their breathing stopped. This explains the unresponsiveness of the patient at the initial phase. As for the burning pain from the patient’s left arm as well as hip; these symptoms were presented due to the opioid injections taken by the patient (Calcaterra et al., 2016). Such injections are the causative factors for the significant amount of necrotic tissue that was found over the forearm and the greater trochanter. The necrotic tissue grew because of the injections made to the muscles and tendons that create clogging since the body began to resist the assimilation of the opioids or they were injected in significant amounts into the system. Such a situation could easily lead to osteonecrosis in which the supply of blood to the bones is relatively insufficient thereby leading to the death of the bone tissue (Nilsen et al., 2017). The Elecctrocadiogram (ECG) showed peaked T waves and a prolonged PR interval, which means that the cell membrane could be impaired thus the probability of the patient having Hyperkalemia.
Various genes may be associated with the development of hyperkalemia. Such a diagnosis is influenced by the significant change in the serum potassium concentration that reached a level of 6.9mEq/L. As the disruption in the potassium gradient occurred the cell membrane was affected that could influence the development of cardiac arrhythmias and neurological symptoms. The potassium gradient is affected due to the transforming myocyte action that affects the trans membrane electrical gradient. There are three major classes of opioid peptides or receptors and they are; endorphins, enkephalins, and dynorphins (Pergolizzi et al., 2017). Each of which is associated with distinct clinical effects although they are all structurally similar with the characteristic carboxy termini and amino acid composition. They consumption of these drugs could lead to the development of a vast array of genetic disorders such as pseudohypoaldosteronism, nephronophthitis, and congenital hypoaldosteronism, among others (Cheon et al., 2015).
At the ED, the patient could be treated through immunosuppression as the potassium concentration levels are at a manageable state considering that there is limited or no possibility of severe neurological or hemodynamic consequences as the level has not exceeded 7mEq/L. The immunosuppression measures have to consider two possibilities with the first being whether the T waves are a sign of hyper acute ST elevation of myocardial infarction. In such a case, the clinicians ought to focus on adjunct pharmacotherapies as well as urgent reperfusion. The second consideration is determining the presence of hyperkalemia, which requires the administration of intravenous calcium gluconate to stabilize the cardiac membrane (Hooman Khademi et al., 2016). These management approaches could be interpreted wrongly due to the failure of integrating the ECG findings properly, thereby impacting the patient’s body system
References
Calcaterra, S. L., Yamashita, T. E., Min, S. J., Keniston, A., Frank, J. W., & Binswanger, I. A. (2016). Opioid prescribing at hospital discharge contributes to chronic opioid use. Journal of general internal medicine, 31(5), 478-485.
Cheon, K. R., Cho, D., Lee, K. S., Cho, H. J., & Jeong, I. S. (2015). Transfusion associated hyperkalemia and cardiac arrest in an infant after extracorporeal membrane oxygenation. Korean Journal of Critical Care Medicine, 30(2), 132-134.
Hooman Khademi, M. D., Farin Kamangar, M. D., Paul Brennan, M. D., & Reza Malekzadeh, M. D. (2016). Opioid therapy and its side effects: a review. Archives of Iranian medicine, 19(12), 870.
Nielsen, S., Sabioni, P., Trigo, J. M., Ware, M. A., Betz-Stablein, B. D., Murnion, B., … & Le Foll, B. (2017). Opioid-sparing effect of cannabinoids: a systematic review and meta-analysis. Neuropsychopharmacology, 42(9), 1752-1765.
Pergolizzi, J. V., LeQuang, J. A., Berger, G. K., & Raffa, R. B. (2017). The basic pharmacology of opioids informs the opioid discourse about misuse and abuse: a review. Pain and therapy, 6(1), 1-16.
