Bimonthly blended assessment - June 2021 July 03, 2021
I have been given the following cases to solve in an attempt to understand the topic of 'patient clinical data analysis 'to develop my competency in reading and comprehending clinical data including history ,clinical findings, investigation and diagnosis and come up with the treatment plan.
This is the link of questions asked regarding the cases:
http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1
Below are my answers to the medicine assignment based on my comprehension of the cases.
QUESTION:1
Below are my answers to the medicine assignment based on my comprehension of the cases.
- he anatomical localization of the problem is at the bronchioles.
- etiology-its is due exposue of dust /allergens in paddy feilds
- anatomical location and pathophysiology
*Abrupt cessation of chronic alcohol consumption unmasks these changes with a glutamate-mediated CNS excitation resulting in autonomic overactivity and neuropsychiatric complications such as delirium and seizures.The latter are usually of generalized tonic–clonic type and are mediated largely in the brainstem by abrogation of the tonic inhibitory effect of the GABAergic delta subunits.
b)
1. IVF NS and RL
mechanism:Administer intravenous (IV) fluids for rehydration, as necessary. Most patients with severe alcohol withdrawal are significantly dehydrated, and their fluid requirements range from 4-10 L in the first 24 hours. Because hypoglycemia is common in these patients due to depleted glycogen stores, a 5% dextrose solution (in 0.90% or 0.45% saline) should be used to prevent hypoglycemia.
Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue
d)
thiamine is used to form thiamine pyrophosphate, which is an essential co-factor used by several cellular enzymes.3 The pyrophosphate portion added to thiamine is important since this group is used to bind to magnesium and then further bind to amino acid side chains on the cellular enzyme.3 This allows the thiamin pyrophosphate to function as a co-factor to that enzyme so that it can facilitate the forward movement of its assigned biochemical reactions. One of the most important sets of biochemical reactions requiring the availability of thiamine includes the reactions involved in glycolysis and the tricarboxylic acid (TCA) cycle. There are three enzymes that facilitate several reactions involved in these processes that require the presence of thiamine pyrophosphate. These enzymes are a-ketoglutarate dehydrogenase, branched chain amino acid dehydrogenase, and pyruvate dehydrogenase. The forward movement of glycolysis and the TCA cycle are essential for the cell's ability to generate the ATP needed to maintain other cellular activity.
e)
The sudden removal of alcohol can also cause kidney failure. Alcohol has to be broken down and cleared from the body as urine. This needs water, as the products of the breakdown have to be in solution.
Alcohol also inhibits the production of an anti-diuretic hormone, so large quantities of alcohol make you urinate a lot and become dehydrated. Electrolytes in the body, such as sodium, magnesium, calcium and potassium, are usually in solution (water) and excessive amounts of alcohol can cause an imbalance in these electrolytes as well as an acid-base imbalance. These imbalances can eventually lead to acute kidney failure.
f)
the affected kidney leads to
1) a moderately reduced red cell life span,
2) blood loss, and
3) an inadequate increase in erythropoiesis relative to the fall in hemoglobin (Hb).
g)
A-Fib and Biatrial Thrombus in a 52yr old Male
1. TAB. Dytor
mechanism: Through its action in antagonizing the effect of aldosterone, spironolactone inhibits the exchange of sodium for potassium in the distal renal tubule and helps to prevent potassium loss.
2. TAB. Acitrom
mechanism: Acenocoumarol inhibits the action of an enzyme Vitamin K-epoxide reductase which is required for regeneration and maintaining levels of vitamin K required for blood clotting
3. TAB. Cardivas
mechanism:Carvedilol works by blocking the action of certain natural substances in your body, such as epinephrine, on the heart and blood vessels. This effect lowers your heart rate, blood pressure, and strain on your heart. Carvedilol belongs to a class of drugs known as alpha and beta-blockers.
4. INJ. HAI S/C
MECHANISM:Regulates glucose metabolism
Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue
5.TAB. Digoxin
mechanism:
Digoxin has two principal mechanisms of action which are selectively employed depending on the indication:
Positive Ionotropic: It increases the force of contraction of the heart by reversibly inhibiting the activity of the myocardial Na-K ATPase pump,
an enzyme that controls the movement of ions into the heart.
6. Hypoglycemia symptoms explained
7. Watch for any bleeding manifestations like Petechiae, Bleeding gums.
8. APTT and INR are ordered on a regular basis when a person is taking the anticoagulant drug warfarin to make sure that the drug is producing the desired effect.
c)
*cardiorenal syndrome type 4 is seen in this patient.
e)
APTT and INR are ordered on a regular basis when a person is taking the anticoagulant drug warfarin to make sure that the drug is producing the desired effect.
