Unstable angina and Hyperosmolar hypoglycaemic nontetotic syndrome
Question one Of the five problems (Dehydration, Tachycardia, Decreased level of consciousness, Hyperglycemia, and Hyperkalemia), Hyperglycemia should be given first priority…
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Reduced levels of insulin make it hard for the body to convert glucose into glycogen resulting into excess levels in the blood (Hu, Pan, & Sun, 2012). Hyperglycemia can result into other complications such as ketoacidosis and hyperkalemia. Insulin deficiency results into a potassium shift from the intra-cellular to the extracellular space (Margassey & Bastani, 2001). This can also occur due to increased osmolality that accompanies hyperglycemia. Hyperglycemia also results into dehydration as the body disposes excess glucose through urine leading to excessive water loss. The complication is also responsible for decreased consciousness. Therefore, by treating hyperglycemia, one will prevent worsening of the other three conditions. Insulin, infusion should be conducted first to deal with hyperglycemia.
This will further result into the movement of potassium from the extra-cellular space to the intracellular space (Lehnardt & Kemper, 2011). Treatment of hyperglycemia will have an immediate impact on dehydration and decreased consciousness, and will stop worsening of Hyperkalemia and tachycardia by extension. Hyperglycemia can be treated in different ways. Glucotrol can be used to stimulate the pancreas to release insulin. Acarbose can be used to block enzymatic action on carbohydrates, while metformin or pioglitazone can be used to increase tissue sensitivity to insulin (Ripsin, H, & Urban, 2009). The goal tachycardia therapy should be to slow down the first heart rate. Several strategies might be used such as the Vagal maneuvers and medications. In practice, medications are offered when the vagal maneuvers fail. Patients can take flecainide or propafenone. Cardioversion can also be used in emergency situations (University of Michigan Health System, 2012). The management of Tachycardia should be conducted with the help of ECG monitoring Hyperkalemia should then be tackled. Examination of Hyperkalemia must be conducted in a systematic level and this should include cardiac function, in addition to the urinary tract, hydration status and neurological processes (Margassey & Bastani, 2001). Normally, individualized therapeutic strategies should always be employed in the management of hyperkalemia. The management should be guided by the specific findings regarding the level of potassium in the blood. Treatment needs to be hurried up due to the fact that the faster the rise of potassium level the greater the chances of toxicity (Karet, 2009). Identification of the cause is key to establishing the desired treatment procedure. In the current case, it is evident that the hyperkalemia results from hyperosmolar hyperglyceamic Nonketotic syndrome which the patient is known to have. The condition is described as a complicated case of diabetes mellitus, particularly type 2, in which high levels of blood sugar result into dehydration, increase in osmolarity, and an increased rate of complications that might result into death (Karet, 2009). The current case of hyperkalemia is most likely as a result of the increased shift of potassium from the intracellular to the extracellular space (Barker, Burton, & Zieve, 2003). Question two Hyperthermia refers to a state where body temperatures are elevated due to a failure in thermoregulation mechanism characterized by the absorption of more heat than that which is eliminated (Hauber, Mohamed, Johnson, & Falvey, 2009). There are several causes of hyperthermia which include effects of drugs, heat stroke and other medical
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