Case Study: Rhabdomyolysis PDF

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A roommate finds a 27-year-old patient with a history of drug abuse in a hazardous condition. The patient was unconscious and unresponsive. Emergency medical services (EMS) were notified for immediate medical help. The EMS administers Naloxone to treat the drug overdose since the patient was uncons...

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Case Study Analysis: Rhabdomyolysis

Vida Shojaei

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Why the patient presented with the symptoms described ( I think top should be centered, correct? Not sure about APA) A roommate finds a 27-year-old patient with a history of drug abuse in a very dangerous condition. The patient was unconscious and unresponsive. Emergency medical services (EMS) were notified for immediate medical help. The EMS administers naloxone to treat the drug overdose since the patient was unconscious in this case. Naloxone is a narcotic reversal (opioid reversal) drug is used in an emergency (National Institute on Drug Abuse, 2020). The patient has been unconscious for an unknown time. However, after administering Naloxone, the patient regains consciousness. Furthermore, ED analysis of the patient shows a large amount of necrotic tissue around the forearm and greater trochanter from the cause of trauma and being immobile for a long period. Clinically the patient’s main diagnosis is drug overdose and narcotic abuse. The overuse of narcotics can lead to rhabdomyolysis, pressure and crush injury; evidenced by the patient complaining of burning pain over his left hip and forearm. Assessment and diagnostic testing showed a large amount of necrotic tissue over the greater trochanter, hip, and forearm. After the assessment and examination, the blood work showed an increase in potassium level 6.9mEq/L and EKG showed a prolonged PR interval and peaked T waves. The complication of rhabdomyolysis led to hyperkalemia, electrolyte abnormalities, kidney failure, low blood calcium and compartment syndrome, Hyperuricemia, and Hypoalbuminemia (Guzman, 2019). Identify the genes that may be associated with the development of the disease

Running head Several genes contribute to the development of rhabdomyolysis disorders. The scenario involving the patient found unconscious is drug-induced rhabdomyolysis. The variation of DRD2 and BDNF genes favors dependency on opioid substances (Torres et al., 2015). Continued abuse of opioid substances affects these two genes, which are critical encoders that induce molecules to change normal bodily physiology such as ATP production for the muscle functions (McCance and Huether, 2018). Therefore, a genetic mutation resulting from opioid abuse contributes to mitochondrial disorders, metabolic myopathies, and muscular dystrophies, among other diseases. The genetic disorders resulting from the variation of DRD2 and BDNF gene contributes to deficiency of muscle enzymes, consequently affecting glycogen decomposition leading to the development of the disease. Genetic myopathies that contribute to the development of the disease include glycogen storage disease, purine metabolism disorder, and lipid storage disease that inhibit mitochondria function hence muscle necrosis.

Information to add on rhabdomyolysis: Please don’t copy (copied and posted from web) Please be sure to use the provided information. Thank you so much.

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Mutations in the CPT2 gene,are the most common cause of rhabdomyolysis due to fatty acid oxidation disorders144. The condition manifests in late childhood to early adolescence and, for unknown reasons, more commonly in males1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437836/

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Genetic muscle diseases that cause rhabdomyolysis

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Several inherited genetic disorders, such as McArdle's disease and Duchenne's muscular dystrophy, are predisposing factors for the syndrome. Clinical features are often nonspecific, and tea-colored urine is usually the first clue to the presence of rhabdomyolysis.

https://www.aafp.org/afp/2002/0301/p907.html This is a good sources

Explain the process of immunosuppression and the effect it has on the body system: Information to add: Please don’t copy (copied and posted from web) Please be sure to use the Bold and Highlighted information. Thank you so much. Mec hani s msOfAc t i on:HowDoDr ugsAndAl cohol Affec tAWeakI mmuneSy s t em?

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Cocai nei mpai r st heefficacyofI L6,apr ot ei nr esponsi bl ef ort hebody’ s chai nofi mmuner eact i onsneededt ofightoffi nf ect i ousdi seases.Fort hi s r eas on,c oc ai neus er sar emor el i k el yt ohav ei nf ec t i ousdi s eas es ,f r om t hec ommon col dt oHI V.

https://theduneseasthampton.com/dangers-drug-alcohol-abuse-weak-immune-system

Can rhabdomyolysis lead to autoimmune disease? Autoimmune Myopathies Autoimmune Myopathies The autoimmune myopathies are a heterogeneous family of diseases, including dermatomyositis and polymyositis, characterized by muscle weakness, elevated CK levels, and lymphocytic infiltrates on muscle biopsy. Affected patients require immunosuppressive agents to control their disease. Although the onset of myositis is typically subacute, it may present acutely with typical features of rhabdomyolysis, including muscle pain and marked CK elevation. Indeed, autoimmune myositis has been described in a significant proportion of adult and pediatric rhabdomyolysis cases4, 84. As patients with myositis often have other systemic manifestations of autoimmunity, these features may help guide clinicians to the correct diagnosis. For example, the presence of heliotrope rash and/or Gottron papules, are pathognomonic for dermatomyositis85. Additional features of systemic autoimmunity seen in patients with dermatomyositis and polymyositis include arthritis, interstitial lung disease, and fever. As noted above, we do not usually recommend muscle biopsy at the time of acute rhabdomyolysis presentation, since delaying biopsy allows muscle cells to regenerate and ensures that overwhelming necrosis does not obscure the underlying pathology indicative of certain inherited conditions. However, since rapid initiation of immunosuppressive therapy may be indicated in suspected myositis, biopsy may be required to confirm the presence of lymphocytic cellular infiltrates and/or perifascicular atrophy. Of note, patients with immunemediated necrotizing myopathy may have prominent necrosis on muscle biopsy without inflammation, making a histologic diagnosis of an autoimmune process challenging. In these cases, testing for antibodies associated with autoimmune necrotizing myopathies (i.e., anti-signal recognition particle or anti-HMG-CoA reductase autoantibodies) may facilitate making the correct diagnosis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437836/

Running head References

National Institute on Drug Abuse. (2020, February 20). Opioid Overdose Reversal with Naloxone (Narcan, Evzio). Retrieved from https://www.drugabuse.gov/related-topics/opioidoverdose-reversal-naloxone-narcan-evzio

Rhabdomyolysis. (2019, November 8). Retrieved from https://emedicine.medscape.com/article/1007814-overview

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Instructor’s comments:

APA formatting. Please be sure that you are following the most recent edition of APA. This should be seventh edition APA. No abstract is required for this case analysis . Please be sure to review appropriate heading levels to use in your case analysis.

Please see if we can keep at 2 pages only.

Running head Please review, correct and check on the grammar. The first part Why the patient presented with the symptoms described, the whole paragraphs needs grammar and sentence correction....