Patient Presentation, Physiologic Response, and Cells involved ALTERATIONS IN CELLULAR PROCESSES Role of Genetics

 

The patient may be partially in so much pain due to the lack of opioids working in their system. The patient received Naloxone in the field which reversed the effects of the substance they took. Another likely reason that the patient is suffering from pain in those areas is due to Rhabdomyolysis. According to McCane and Huether, Rhabdomyolysis can be a life-threatening condition in which contents of the muscle cell are released into circulation (2019). Substances can cause Rhabdomyolysis through prolonged immobilization or drug-induced energy demands, such as seizures, dystonic reactions, and hyperthermia (Bhai & Dimachkie, 2023). We do not know how long he had been down and do not know if he suffered from any seizures, but we can infer that it was likely one or multiple of these issues that caused the Rhabdomyolysis. In Rhabdomyolysis, damage to the muscle cells causes a disruption of the Sodium and Potassium pump within the cells (Torres et al, 2015). In normal, uninjured, muscle cells contain lower levels of intracellular Sodium and Calcium, and higher levels of Potassium (Torres et al, 2015). Depolarization of the muscle causes a surge of calcium to enter the cytoplasm, leading to contraction of the muscle (Torres et al, 2015). This is all dependent on ATP. In the injured muscle, there is a depletion of ATP, causing an increase of sodium and calcium in the cell, leading to an increase of water in the cell (Torres et al, 2015). Also, an elevated level of Calcium will cause activation of proteases and phospholipases, causing lysis of the cell’s membrane (Torres et al, 2015). If this sustains, it ultimately causes muscle necrosis (Torres et al, 2015). We also learned that he has high levels of potassium in his blood, showing further evidence that he does, in fact, have Rhabdomylosis. The EKG changes that we are seeing are directly related to the potassium levels in the blood. According to McCance and Huether, EKG changes of peaked T waves and a prolonged PR interval can be caused by high levels of potassium (2019).  Some genetic factors that I would be curious about and may change my answer to the cause of the Rhabdomylisis would be if the patient had lipid, carbohydrate, or purine metabolism deficiencies, as these are some predispositions to Rhabdomylolysis (McCance & Huether, 2019). 

This 16-year-old patient from NURS 6501 ALTERATIONS IN CELLULAR PROCESSES was presented to the PCP, and we diagnosed them with strep throat. The cells have gone through an extracellular matrix (McCance & Huether, 2019) and are now injured due to infection. The PCP prescribed the antibiotic to reverse the injury. The damage to the cell itself causes the patient to have a reddened pharynx and enlarged tonsils with white patches. The 16-year-old cells are also experiencing hypertrophy, causing an increase in size in the tonsils. 

After this patient took two doses of amoxicillin 500mg, they experienced tongue and lips swelling, difficulty breathing, and audible wheezes. This patient is presenting with anaphylaxis. This is an IgE-mediated reaction. IgE antibodies are produced in the immune system. This is considered a type 1 hypersensitivity reaction. The binding of Fc receptors on mast cells and basophils to IgE triggers mast cells and creates an allergic reaction. Enzymes tryptase cause tissue damage, and TNF causes inflammation (Justiz-Vaillant & Zito, 2019). 

Initially, when the patient was presented, they had no known drug allergies. The new drug allergy can connect to the infection, especially if it is recurrent. To verify that the amoxicillin allergy is a true allergy, the PCP can use an allergic test called a radioallergosorbent test (RAST) (Justiz-Vaillant & Zito, 2019).    

The patient’s anaphylaxis is generalized and not systemic. A study showed that penicillin was reported for 40.7% of antibiotics causing anaphylaxis. In the same survey, it is said that the female gender is more likely to have drug-induced anaphylaxis. Patients with several comorbidities or other medications may also be at higher risk (Regateiro, Marques, & Gomes, 2020). 

Reference: 

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions Download Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/