Case Study

Question 1

Of the five listed problems choose the one which you believe requires the highest priority when planning the management of Mr Smith. In essay style, justify why you believe this problem is the highest priority for Mr Smith and why this should be managed ahead of his other listed problems.

Among the problems that are listed above, Hyperkalemia is considered to be such a problem that requires attention on high priority basis when the planning has been made for the management of Mr. Smith. Hyperkalemia is a condition disease in which there are an excess of potassium (Latin name: kalium) in the plasma of blood. In humans, it is defined from a concentration greater than 5 mmol / L. From 7 mmol / L, cardiac arrest may occur at any time, making hyperkalemia one pathology at risk. Most of the time it is detected by chance because there is no particular symptom that could be associated to this medical problem. Everything really depends on the concentration. The reason for selecting this problem as of high priority is this that this disease has no particular symptom of occurrence and is very much difficult to track this problem once occurred. This is the reason that it should be given preference more than other problems that are being faced by Mr Smith currently. The causes of this problem and their treatment are discussed below (Kollef, 2008).

Causes of hyperkalemia

There are many. Among the most common are:

one kidney;

some medicines;

a contribution in excess of potassium intravenously;

Deficient insulin (type 1 diabetes).

Treatment

The key question is: should transfer the patient in ICU for medical treatment? This question is directly related to the presence or absence of threatening hyperkalemia. Schematically, the support should be in ICU with maximum processing if at least one of these factors is present:

there are significant abnormalities on the ECG,

hyperkalemia is greater than 6.5 mmol / L (6 mmol / l if there are abnormalities in the ECG) ,

hyperkalemia is acute

There are poor prognostic factors: acidosis, hypoxia, hypocalcaemia, and preexisting heart disease.

Outpatient

It is possible that if the ECG was normal, moderate hyperkalemia, chronic, well tolerated and there is no cardiac or metabolic disorder superimposed. The treatment is then based on simple measures to control serum potassium to an acceptable level, as well as regular monitoring by electrolytes blood. The treatment of the case, where possible, is essential.

It rests on a diet excluding foods rich in potassium, prescription of ion exchange resin (sodium polystyrene) to be taken orally, and the correction of any acidosis (water Vichy or preparations Masterworks).

Treatment Hospital

The goal of treatment is to reduce hyperkalemia, and thus protect the heart rhythm disorders. Several techniques are used. The calcium gluconate (10 ml ampoule intravenously) may be administered first (otherwise it will precipitate with bicarbonate): the calcium antagonizes the cardiac effects of hyperkalemia in cases of arrhythmia. Its effectiveness is fast but short infusion is renewable with serum glucose infusion of ...