CASE Study 2-1 Metabolic and Endocrine PDF

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Case Study Med Surg II Metabolic and Endocrine...

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CASE STUDY 1 – Metabolic and endocrine 1. Carl Vinson, a 65-year-old Caucasian man, was admitted today with increased shortness of breath, fatigue, and decreased level of consciousness. Mr. Vinson has a history of liver disease, most likely related to a long history of alcohol use. Upon arrival to the unit, he is somnolent and responds only to shouting and shaking. Upon arousal, he is only able to state his first name. His wife accompanies him to the unit and describes that he has become increasingly restless over the last 3 days, and she is concerned for his safety. Additionally, he has not eaten or taken in any fluids in 24 hours. a. The physician orders a STAT ammonia level, along with a CBC and complete chemistry panel. The ammonia result is elevated. What is your interpretation? – elevated ammonia=kidneys are functioning properly; poisonous (hepatic encephalopathy); neurological signs; burning of the eyes, nose, throat and respiratory tract and can result in blindness, lung damage or death. Inhalation of lower concentrations can cause coughing, and nose and throat irritation; Urea activates GABA receptors b. The physician orders Mr. Vinson to receive lactulose (Cephulac) orally. What is the rationale for this medication? Laxative and ammonia reducer; reduce ammonia in the blood; diarrhea is normal due to lactulose absorbing water from the body into the colon c. Mrs. Vinson asks if protein should be reduced in his diet. How will you respond to her question? When the body digests proteins it creates a byproduct, ammonia. A damaged liver cannot handle a normal/high protein diet. d. Flumazenil – GABA receptor antagonist...