Question

Mr. P. F., a 68-year-old man, is admitted to the medical intensive care unit from the emergency department with respiratory failure and hypotension. His history is significant for type 2 diabetes mellitus, steroid-dependent chronic obstructive pulmonary disease, peripheral vascular disease, and cigarette and alcohol abuse. His medications at home include glipizide, prednisone, and Combivent. In the emergency department he received a single dose of ceftriaxone and etomidate for intubation.

On medical examination he is intubated, on pressure-controlled ventilation, and receiving normal saline at 200 mL/hr and dopamine at 8 mcg/kg/min. His blood pressure is 86/50 mm Hg; heart rate, 126 beats/min; oxygen saturation, 88%; and temperature, 39.6?C. His cardiac rhythm shows sinus tachycardia and nonspecific ST-T wave changes. Arterial blood gas values are as follows: pH, 7.21; PaO2, 83 mm Hg; PaCO2, 50 mm Hg; and bicarbonate, 12 mEq/L. Other lab values are as follows: serum glucose, 308 mg/dL; serum creatinine, 2.1 mg/dL; and white blood cell count, 19,000/?L.

Questions:

What disease state do you suspect this patient is experiencing and why?
What potential endocrine complications do you anticipate?
What further laboratory studies would you want? What results do you anticipate?
What treatment goals and strategies do you anticipate?
In providing patient and family education and support, what issues need to be addressed immediately and which can be delayed?

Answer 1

Ans: 1· The diseases state that this patient may be experiencing may be COPD (chronic obstructive pulmonary disease) due to alcohol abuse, as prednisone is one of the drugs prescribed in this situation. The patient is also suffering with type 2 diabetes mellitus Further the drug Combivent; prevents the bronchospasm in patients with chronic obstructive pulmonary disease. Further the lab reports confirm this diagnosis 2. In 68 year old man with history of diametes mellitus and blood glucose levels 308 mg/dl, the endocrine complication involved is insulin impairement. Since, insulin is not efficient enough to control blood glucose levels; it resulted in peripheral vascular disease. The other conditions of COPD, respiratory failure and hypotension further lead to tachycardia. The patient's habits like smoking and alcohol abuse have aggravated his condition. Some infection is present in the body and is known by white blood cell count 19000/microliter and receiving single dose of ceftriaxone antibiotic. The thyroid function is also suspected along with insulin impairment and these two hormones are related to endocrine system.

4. In 68 year old man with history of diametes mellitus and blood glucose levels 308 mg/dl, the endocrine complication involved is insulin impairement. Since, insulin is not efficient enough to control blood glucose levels; it resulted in peripheral vascular disease. The other conditions of COPD, respiratory failure and hypotension further lead to tachycardia. The patient's habits like smoking and alcohol abuse have aggravated his condition. Some infection is present in the body and is known by white blood cell count 19000/microliter and receiving single dose of ceftriaxone antibiotic. The thyroid function is also suspected along with insulin impairment and these two hormones are related to endocrine system 5. In this scenario patient is in a respiratory acidosis state and on ventilator. So we should give information to the family about respiratory acidosis and provide information about what is respiratory acidosis and what treatment should be given, and importance of ventilator support in this condition and need of ICU care. Also should inform about his blood pressure and infection because his blood pressure is 86/50 mmHg on inotrops and NS 200 ml /hr. His WBC count is 19,000 and started antibiotics. The issues like blood glucose level and creatine level can inform later because patient was on steroid and there must be chance of high blood suger level. Also patient is on hypotension and therefore mild kidney disfunction will be there. Psychological support should provide the family too