Question-1: A 5-year-old child is brought to the hospital with the complaint of fever, cough, breathlessness
and chest pain. On examination he is found to be dull, but irritable with fast pulse (116/min),
rapid breathing (RR 50/min) and indrawing of lower chest during inspiration, wheezing, crepitations
and mild dehydration. Body temperature is 40°C (104°F). The paediatrician makes a provisional
diagnosis of acute pneumonia and orders relevant haematological as well as bacteriological investigations.
He/she decides to institute antibiotic therapy.
(a) In case he/she selects an antibiotic which can be given orally as well as by i.m. or i.v. injection, which route of administration will be most appropriate in this case?
(b) Should the pediatrician administer the antibiotic straight away or should he wait for the laboratory reports?
solution:(a) Since the child is seriously ill, a fast and more predictable action of the antibiotic is needed; a parenteral route of administration is appropriate. Moreover, oral dosing may be difficult in this case as the child is dull and irritable. Entering a vein for i.v. injection is relatively difficult in children, particularly in the presence of dehydration. Therefore, the antibiotic may be injected i.m. However, if an i.v. line is set up for re-hydration, the antibiotic may be administered through the i.v. line.
(b) In this case the provisionally selected antibiotic should be started as early as possible, because the child is seriously ill. Waiting for the lab reports to confirm the diagnosis/select the definitive antibiotic may compromise the prognosis.
**For more visit and like our facebook page**
Question-2: A 60-year-old woman complained of weakness, lethargy and easy fatigability. Investigation showed that she had iron deficiency anaemia (Hb. 8 g/dl). She was prescribed cap. ferrous fumarate 300 mg twice daily. She returned after one month with no improvement in symptoms. Her Hb. level was unchanged. On enquiry she revealed that she felt epigastric distress after taking the iron capsules, and had started taking antacid tablets along with the capsules. Now the question was what could be the possible reason for her failure to respond to the oral iron medication?
Solution: Gastric acid is required for the absorption of oral iron salts. Concurrent ingestion of antacid tablets could have interfered with iron absorption. Hence, the anaemia failed to improve.
Question-3: A 50-year-old type-2 diabetes mellitus patient was maintained on tab. glibenclamide (a sulfonylurea) 5 mg twice daily. He developed toothache for which he took tab. aspirin 650 mg 6 hourly. After taking aspirin he experienced anxiety, sweating, palpitation, weakness, ataxia, and was behaving abnormally. These symptoms subsided when he was given a glass of glucose solution.
(a) What could be the explanation for his symptoms?
(b) Which alternative analgesic should have been taken?
Solution:(a) Aspirin displaces sulfonylureas from plasma protein binding sites. Therefore, plasma concentration of unbound (and active) glibenclamide would have risen after aspirin ingestion causing hypoglycaemia which produced the symptoms. As such, glucose ingestion relieved the symptoms.
(b) Paracetamol and ibuprofen are analgesics equally effective in toothache as aspirin, and do not displace or otherwise interact with sulfonylureas. As such, these analgesics are more suitable for the given patient.
**For more visit and like our facebook page**
(a) In case he/she selects an antibiotic which can be given orally as well as by i.m. or i.v. injection, which route of administration will be most appropriate in this case?
(b) Should the pediatrician administer the antibiotic straight away or should he wait for the laboratory reports?
solution:(a) Since the child is seriously ill, a fast and more predictable action of the antibiotic is needed; a parenteral route of administration is appropriate. Moreover, oral dosing may be difficult in this case as the child is dull and irritable. Entering a vein for i.v. injection is relatively difficult in children, particularly in the presence of dehydration. Therefore, the antibiotic may be injected i.m. However, if an i.v. line is set up for re-hydration, the antibiotic may be administered through the i.v. line.
(b) In this case the provisionally selected antibiotic should be started as early as possible, because the child is seriously ill. Waiting for the lab reports to confirm the diagnosis/select the definitive antibiotic may compromise the prognosis.
**For more visit and like our facebook page**
Question-2: A 60-year-old woman complained of weakness, lethargy and easy fatigability. Investigation showed that she had iron deficiency anaemia (Hb. 8 g/dl). She was prescribed cap. ferrous fumarate 300 mg twice daily. She returned after one month with no improvement in symptoms. Her Hb. level was unchanged. On enquiry she revealed that she felt epigastric distress after taking the iron capsules, and had started taking antacid tablets along with the capsules. Now the question was what could be the possible reason for her failure to respond to the oral iron medication?
Solution: Gastric acid is required for the absorption of oral iron salts. Concurrent ingestion of antacid tablets could have interfered with iron absorption. Hence, the anaemia failed to improve.
Question-3: A 50-year-old type-2 diabetes mellitus patient was maintained on tab. glibenclamide (a sulfonylurea) 5 mg twice daily. He developed toothache for which he took tab. aspirin 650 mg 6 hourly. After taking aspirin he experienced anxiety, sweating, palpitation, weakness, ataxia, and was behaving abnormally. These symptoms subsided when he was given a glass of glucose solution.
(a) What could be the explanation for his symptoms?
(b) Which alternative analgesic should have been taken?
Solution:(a) Aspirin displaces sulfonylureas from plasma protein binding sites. Therefore, plasma concentration of unbound (and active) glibenclamide would have risen after aspirin ingestion causing hypoglycaemia which produced the symptoms. As such, glucose ingestion relieved the symptoms.
(b) Paracetamol and ibuprofen are analgesics equally effective in toothache as aspirin, and do not displace or otherwise interact with sulfonylureas. As such, these analgesics are more suitable for the given patient.
**For more visit and like our facebook page**
No comments:
Post a Comment