Introduction and Reference Table
Patient Results and Reference Ranges for Biochemical Tests Performed on 62-year-old Patient
Test Patient Results Reference range Normal or Abnormal?
Sodium 148 mmol/L 135-145 mmol/L Above reference range
Potassium 4.5 mmol/L 3.5-5 mmol/L Normal
Urea 6.0 mmol/L 2-6.6 mmol/L Normal
Creatinine 105 µmol/L 70.72- 114.92 µmol/L Normal
Bicarbonate 22 mmol/L 18-22 mmol/L Normal
pH 7.40 7.35-7.45 Normal
Understanding diseases such as obesity, hypertension, high sodium levels in the body and even cerebral edema is a fundamental requirement, as these are lethal ailments. Obesity is on the rise in many nations across the globe. For instance, studies classify many young people in the world as obese and very prone to heart diseases. A good number of parents do not regulate their children’s feeding habits hence results to high obesity levels in many states. Watching television without doing exercises, particularly after meals, is one of the major reasons behind the widespread obesity among the young generations. In addition to the children, the middle-aged persons are having the same problem in so many countries the world that some governments declare it as a national epidemic. Most working class individuals rely on fast food products, as they are cheap, sweet and very convenient for their lifestyles. Fast food commodities have unregulated sugar concentration. A study by the World Health Organization did realize that many fast food restaurants include high levels of sugar in their products, a reason the researchers cite as the base behind the increase in obesity levels as well as high sugar levels. However, political carnage did lead to disregard of the World Health Organization report with many right groups citing corruption behind the political standoff for the matter. Hypertension is no longer an old-age disease, today even the youth suffer from the disease at their tender ages. High blood sugar results to other opportunistic diseases such as ulcers and heart failure due to the concentration of cholesterol in the main blood arteries, veins, and capillaries, resulting to vasodilatation or vasoconstriction depending on the level of accumulation. For these reasons, a good comprehension of the best food products for a healthy life is crucial. In addition to these diseases, a high concentration of sodium ions in the body is indeed lethal particular towards the formation of a glomerular filtrate in the course of urine formation. The sodium ions can make the Loop of Henley absorb excess water leading or release a lot of water to reduce the concentration leading to dehydration in all the circumstances. For that reason, maintain a good level of sodium ions is crucial for a healthy body. Edema or just cerebral edema is a condition that results in the brain being spongy due to a high level of fluids, a scientific process known as hydrosarfalism. The condition makes the brain overfill the cranial cavity and the ventricular vaults compress. Hence, cerebral edema is a dangerous disease. Analysis of the diseases: obesity, hypertension, high sodium levels and edema reveal an evolving state of existence f these diseases hence proper and drastic medical procedures are fundamental for healthy living. The paper undertakes an investigation of the above diseases and others through a literature review sort of laboratory examination that seeks to identify the areas of concern. In addition to that, the paper highlights the applicability of the medications such as Rampril, Gliclazide, Indomethacin, and Bendroflumethiazide in the treatment of the above conditions. The medicines are in common use in a wide scope because of the trust many people have in the medical field under the Center for Disease Control that carries out both pathological and pharmaceutical studies. Researchers do tireless experiments on various diseases to ascertain the best approach to treating them; hence, many of the medical procedures originate from their laboratories. Demand for speed and precision in the medical field does lead to improvement and constant investigations on killer diseases. For that reason, many people from the African continent have had to seek medical attention from India because of the advancement the country has had in the health industry. It is recommendable to have quality and substantive medical practitioners and laboratories so that meeting the demands of emerging trends can be easy as well as giving such developments the best attention they deserve. Diseases are evolving. Human beings are facing more stringent illnesses than a century ago as well as other living organisms. For instance, the outbreak of Ebola, which results in hemorrhage-like conditions, did catch the medical fraternity unawares. In addition to that, the example from the Ebola outbreak, the emerging diseases are contagious, eradicate human life very fast and prove elusive to the common treatment procedures. Medical practitioners have had a rough time dealing with such ailments. These conditions are hard to diagnose and compose a conclusive treatment plan and even come up with a fast aid procedure for emergency cases. For these reasons, many people tend to lose lives due to lack of proper diagnosis and treatment. In addition to the unavailability of professional personnel who are familiar with these conditions. In addition to the Ebola outbreak, there are other diseases, which evolve or rather their bacterial, or protozoan causing them mutate against the existing medications. For such conditions, medical officers become inefficient and hardly handle patients with the desirable precision. Hence, patients end up dead even after administering the right prescription of medication from a professional physician. Many doctors fail to understand the state of the protozoan or bacterial that causes a particular disease and hence the use of the old methodologies fails. For these perceptions, the paper investigates cerebral edema, Fasting Glucose levels, Obesity across age groups, and even High Sodium levels in the body at different times, to ascertain their symptoms, methods of treatment and their evolution through the years.
Keywords: Diseases, Mutation, Protozoa, Bacterial, Rampril, Bendroflumethiazide, Gliclazide, Indomethacin, Hypertension, Obesity, High Sodium Levels, Hemorrhage, Medications
Laboratory Investigation of Diseases
Analysis of Initial Symptoms
The 62-year-old patient is under multiple threats to their health. They have a high concentration of sodium ions. For the first part, the physician did found that the patient is hypertensive, arthritic and even had signs of edema around their ankles. The reason for that could be that there was the absorption of excess fluids and overflow into even essential organs due to the high sodium concentration. In addition to that, the high amount of fasting glucose in their blood streams gives a reason as to why they are hypertensive though all other essential metals are in normal concentrations in the body. People suffering from hypertension have high risks of acquiring coronary artery disease and even congestive cardiac arrest abnormalities (Khalid, Et al. 2012, Pg. 2). Studies indicate that hypertension is easy to control but the high risks to heart attacks and other deadly scenarios make hypertensive people vulnerable to sudden death. Individuals with a higher fasting glucose, above normal of 110 mg/dl, than the normal 126 mg/dl (Nix, 2013, Pg. 404) have likelihoods of being hypertensive. The analysis reveals why the patient was feeling fatigue and irritable. For that reason, the patient had to receive an IGT or prediabetic medications.
Highlighting the state of various diseases in different environments is crucial towards developing in addition to maintaining a sustainable cure. Human beings do suffer from mutating protozoa or bacterial causing various diseases without a proper response from medical officers. For that reason, a good and comprehensive study touching on the previous manifestations of a disease, its response to the particular medications administered to patients then and its current response to the similar medications now draws a good conclusion on the way forward against such a disease.
Scientific Perception of the Diseases
Cerebral edema is an itchy medical condition. The condition affects the brain and consumes it in entirety.Hhaving a comprehensive pathophysiology and imaging appearance perceptions of edema fundamental in improvising a good cure. Edema is a response to a number of problems relating to the brain, either physical or psychological injury to the head. The brain conditions that can lead to edema are either cytotoxic, interstitial or vasogenic in nature. Combining the radiological examination of the identified dominant imaging patterns of the edema corresponds to a clinical perceptive of understanding the condition (Ho, Rojas, & Eisenberg, 2013, Pg.1). The major symptoms of edema are not specific and the clinical radiological procedures cannot identify the extent of brain damage with the use of CT or MRI for the first and subsequent analysis of the brain tissues. Cytotoxic edema results from ischemia of the cell membranes (Wisner, Zwingenberger, 2015, Pg. 162). The ischemia of the cellular membranes results from swelling of cells, Na/K pump dysfunction or increase in the volume of intercellular fluids. Vasogenic edema results from the movement of fluids between the vasculature and the extracellular space (Donkin, Vink, 2016, Pg. 3) in response to an osmotic gradient as result of leakage of components from the vasculature filtrate into the parenchyma of the brain. The manifestations of the disease include inflammation and intra-cerebral hemorrhage. In addition to that, the influx of water into the vasculature and intracellular spaces leads to increase in IGP and swelling. Interstitial or trans-ependymal edema is another exciting form of cerebral edema in that the condition is situational. Interstitial edema originates from the migration of the CFS in a trans-ependymal pattern (Hoffmann, Lorena, and Castillo, 2016, pg. 9) into the extracellular space in the periventricular white matter.
High Sodium Levels
A high concentration of sodium ions in the body is devastating. Sodium is a crucial metal in the body. An increase of sodium ions in the body decreases the flow of calcium ions (Ignatavicius, Linda, 2015, Pg. 163) that are necessary for blood clotting and even bone formation. Emerging evidence indicates that high sodium ion levels lead to hypertension (Reddy, et al.2015, Pg. 1). Hypertension is a cardiovascular disease and with recent developments in the field of medicine, a high level of sodium ions in the body is a risk factor. In most cases, the cardiovascular changes are observed as cardiac output fluctuations. However, the cardiac response to the hyponatremia with a decrease in the volumes of plasma fluid or hypovolamia, is a weak and rapid pulse that is sort of hypertensive reaction. Sodium ions fluctuation is dangerous to a body system (Ibrahiem, 2015, Pg. 36). Changes of the sodium ions in the serum depend on water percentage. Hyponatremia refers to declining level of serum sodium below 132 mmol/l (Ibrahimien, 2015, Pg. 36) while hypernatremia reflects an increase in serum sodium above 152 mmol/l (Ibrahimien, 2015,Pg. 36).Fluctuations of the sodium level leads to osmolality imbalance. Feeding on a low sodium diet affects both human beings and animals. The main cation of the extracellular fluid is sodium (Smith, Zwart, & Heer, 2014, Pg. 55). The body uses sodium ions to ensure equity in water distribution across the body. Imbalance of osmotic pressure affects the cardiovascular operations. For these reasons, a high sodium ion concentration in the body is pathogenic and can lead to death and a low concentration of sodium ions results in an unnecessary imbalance.
Hypertension is a dangerous disease that affects both men and women in the society. The normal blood pressure for a human being ranges from a systolic pressure of about 120mm Hg to a diastolic pressure of about 80mmHg (Beldar, Balan, and Ahuja, 2015,Pg.3) any value above the standard mark refers to a hypertensive state.
Failure to correct the pressure levels could be fatal as that makes the circulatory system to work extra hard to cater for the deficiency of blood in some critical organs such as the brain. Hypertension leads to fetal and maternal mortality and morbidity levels (Kumar, et al., 2014, Pg. 1). Studies reveal that most pregnancy complications result from high or low blood pressure. During the early gestation period, hypertension can complicate twenty percent of pregnancies; hence, there is a call for attention to reducing the mortality rate. In most cases, pregnancy induced hypertension is a multi-organ disease that can lead to an instant death. Hence, depending on the end organ, the condition can be preeclampsia where there is renal engagement leading to proteinuria or be eclampsia if there is the involvement of the central nervous system leading to seizures. Hypertension makes the body vulnerable to other opportunistic diseases (Weber, Schiffrin, white, and Mann, 2014, Pg. 2). Many hypertensive patients exhibit lipid abnormalities and even imbalances in glucose levels. Depression is a common predicament for most hypertensive persons (Mu, Gao, & Sun, 2013, Pg. 1). However, many epidemiological studies disagree that any relationship exists between hypertension and depression, but practical approaches reveal that low blood pressure results in depressive symptoms.
The body needs carbohydrates for growth and development. Carbohydrates and proteins provide energy and healing mechanisms for a human being’s body in that they help in replenishing lost strength in cells and tissues. The most abundant carbohydrate in the body is glucose. Sodium ions are responsible for the transport and assimilation of glucose (Kumar, Pandey, 2013, Pg. 9). Glucose is easy to absorb and assimilate hence a high concentration becomes lethal to the body. However, any infection affecting the working conditions of the brain degrades the digestion of glucose. For instance, seizures lead to a reduction in energy demands hence leading to a low absorption rate of the simple carbohydrate. Consuming low glycemic foods causes a reduction in glucose in the body (Masino, 2015, Pg. 367). In addition to that, the insulin levels reduce hence a person becomes hypertensive, just as the case with the 62-year-old patient. The person experiences fatigue and an insatiable urge for other metals because of the extra sodium ions that make the absorption of calcium very slow. In some instances, the fasting glucose is higher than postprandial blood glucose in health people. Physiological insulin resistance results to higher fasting glucose than postprandial blood glucose in health individuals (Prabhakar, Pandey, 2014, Pg. 1). Diabetes mellitus is a contributing factor in the above scenario. In addition to that, many people experience that because of the hindrance insulin gets from an increase in sodium ions in the body. For that reason, the 62-year-old patient had an outright reason to start on diabetic medications.
Obesity results in many deaths and healthy complications. Many young people in the world have overweight issues because of over-reliance on fast food products. In addition to that, studies reveal that most of these young people are hypertensive and have ionic imbalances in the bodies. Obesity is a cause of an increase in mortality as well as an increase in the risk factors for many medical conditions from diabetes and depression to cardiovascular complications (Stanford, et al. 2011, Pg. 1). Sudden deaths that cannot have a scientific explanation are on the rise and many of the victims are the overweight individuals hence there is cause for alarm. Many people think that obesity does not lead to death but the condition makes the body vulnerable to deadly attacks. The 62-year-old patient is somehow obese with their fasting glucose and sodium concentrations being high above the normal ranges. For that reason, they are vulnerable to cardiac arrest issues and even fatal seizures because of the vulnerability of their brain tissues. In addition to that, the feeling of fatigue seconds the argument that they are obese. They experience tiredness and irritable because of their old-age and the high concentration of metals in their blood stream that hinder the absorption of other essential substances into the system.
The 62-year-old patient experiences symptoms relating to rheumatoid arthritis. They feel tired and their mobility is reducing at a high rate. In old-age, these are likely occurrences but with health food, they are rare. However, with nutritional imbalance, one can experience them at even tender ages. Developing the right cognitive behavioral therapy (CBT) is a complication because of the differences in many aspects of life (Ehde, Dilworth, & Turner, 2014, Pg. 3). Researchers indicate that over one hundred million adults suffer from chronic pain because of old-age-related ailments. However, they do not attach such experiences to the unhealthy living conditions these people thrive in and hence the remarks are not conclusive. For the case of the 62-year-old patient, it is evident that they have extreme chronic pain because of the deteriorating state of their health.
The medication works well for a diabetic patient. The 62-year-old patient has a mild form of diabetes hence it was necessary to recommend the gliclazide. However, the medicines cause indigestion and a loss of weight. For that reason, the patient could not depend on them as they could hinder their progress.
These tablets treat hypertension hence were necessary because of the initial laboratory analysis of the GP. In addition to that, they counter the excess flow of fluids in the body. However, bendroflumethiazide causes blurred vision, dizziness and high sensitiveness to the sun.
The medication is an enzymatic inhibitor that works by blocking any substance that causes vasoconstriction. For that reason, ramipril improves blood flow to vital organs particularly the heart. In addition to that, ramipril treats hypertension and regulates blood sugar levels in the body. Ramipril medications are enzyme inhibition type and work by inhibiting hence pharmacists classify them as Angiotensin Converting Enzyme Inhibitors (ACEI).
These anti-inflammatory medications are essential to patients with rheumatoid arthritis. They treat pain and fever by blocking the production of prostaglandins in the body. Hence, they were a good prescription to the 62-year-old patient who did experience tiredness and less mobility. However, Indomethacin may increase blood pressure though they are the best for relieving joint stiffness.
Gliclazide and Bendroflumethiazide
A combined-intake of the two medicines above is well informed. However, the result would be catastrophic to the 62-year-old patient as they could lose weight as well as experience blurred vision and dizziness.
Ramipril and Indomethacin
The two would be good for reducing fatigue and blood pressure as well as the fluid concentration in the body. However, Indomethacin would inhibit the reduction of blood pressure by increasing the chances of a high amount of blood sugars possibly by inhibiting the secretion of insulin by the body.
The patient will have high chances of suffering from the following disease,
1. High blood pressure
2. Vision impairment
3. Increased rheumatoid arthritis
4. Indigestion and assimilation complications
The possible diseases the patient may acquire because of the use of the medicines. They can experience an increase in rheumatoid arthritis because of the gliclazide prescriptions. In addition to that, the use of indomethacin could increase blood pressure. For that reason, the patient could experience hypertensive conditions for long. The use of bendroflumethiazide would result in vision impairment.
Acute Tubular Necrosis
Tubular necrosis is a dangerous disease that leads in causing deaths to about fifty percent of the people it infects. The 62-year-old patient had high chances of having the disease of the low blood supply to their renal system. Hypertension is the leading cause of renal tubular necrosis (Henningsen, Kuntz, & Youngs, 2013, Pg. 68). High blood pressure results in the necrosis of the renal tubular nephron. For that reason, since the patient had an initial diagnosis of being hypertensive, the likelihood of them having an acute tubular necrosis is very high. The table below reflects the state of a person with acute tubular necrosis,
Test Acute Tubular Necrosis
Urinary Osmolality < 350 mOsm /Kg/H2O Urine /Plasma osmolal ratio <1.1 Urine/Plasm creatinie ratio <20 Serum urea n/ creatinine ratio <=10 Urine/plasma urea ratio <7 Urinary sediments Casts of tubular cells 2h creatinie clearance Falling Serum urea N/creatinine ratio <=10 Excreted/Filtered sodium (FE Na) >2%
Urine sodium concentration >30 mmol/l
The patient did experience sever vomiting and nauseating. For sick patients at critical state, a feeling of nauseating and vomiting with diarrhea reflects a possible acute tubular necrosis infection to their renal system. Sodium concentration was at normal range but creatinine and urea were above safe ranges. In most cases, an increase in creatinine refers to a severe state of tubular necrosis. The 62-year-old patient did feel tiredness and dizzy probably because of the administration of bendroflumethiazide and indomethacin. However, the above are symptoms of an acute tubular necrosis just as well as the muddy brown casts. The patient’s acute tubular necrosis was toxic. In the world today, the pathophysiology and pathogenesis of acute tubular necrosis are of great concern to many scientists and disease research centers.
Triple Whammy Effect
The 62-year-old patient has high probabilities of acquiring the triple whammy effect. They are under a high dosage of both nonsteroidal anti-inflammatory drug (NSAID) like indomethacin and bendroflumethiazide and Angiotensin Converting Enzyme (ACEI) like ramipril. The 62-year-old patient had a combination of all possible drugs that could give anyone a triple whammy effect. For the reason that the patient is in old-age, and that they had had a renal complication history, and the current set of medications, they did acquire the triple whammy effect. They had to take indomethacin to reduce pain from the rheumatoid arthritis condition. In addition to that, indomethacin did help them improve their mobility. However, the indomethacin did increase their hypertensive state and the concentration of NSAIDs in their blood streams. For the patient to reduce hypertension and improve blood circulation in their body, they had to be under ramipril medicines. The ramipril tablets are Angiotensin Converting Enzyme (ACEI), hence did increase the concentration of ACEIs in their body systems. The ACEIs treat hypertension but have the overall effect of a dilation of the arterioles hence reducing the pressure gradient of blood flowing through the kidney. For that reason, in the body of the patient, there was a direct combination of both NSAIDs and ACEIs, which is the main contributing factor that results in the triple whammy effect. The 62-year-old patient had little chance of evading acquiring the triple whammy effect. Their initial health condition was their weakest position and that did put them vulnerable to even deadly infections.
The patient urine osmolality is 200mOsm/Kg, and an osmolality range 500-850 mOsm/kg water. The osmolality range reduces with an average of about 5 mOsm/kg/year. In most cases, the reduction in the osmolality is because of the following problems to a person,
1. Diabetes insipidus
2. Excessive fluid intake
3. Acute renal insufficiency
Diabetes inspidus is a chronic form of diabetes and in that state, the disease is somehow incurable. For that reason, kidney failure due to high concentration of salts in the urine is very likely. The reason for that could be kidney stones and muddy brown casts from acute tubular necrosis and the triple whammy effect. Acute renal insufficiency is because of depletion in the volume of urine and the high concentration of lethal metals in the urine. Exisistence of muddy brown casts refers to an acute tubular necrosis as well as a fractional sodium secretion of above 1. Muddy brown casts results from severe infection or damage to the kidneys. In such circumstances, the muddy brown casts are granular casts form due to a long-term infection of the renal system. In addition to that, epithelial tract cells that occur at the renal tubular relate to a severe damage of the kidney. The epithelial tract cells form in a bid to rescue the walls of the renal system. However, they then block the urinary track leading to itching feeling during urination. Haemoglobinuria is a condition where urine appears dark. The state refers to existence of oxygenated-blood in the urine probably that is from the circulation system. The blood might overflow and get detoxificated by the liver or the spleen and appear in urine. For that case, the condition indicates that the patient has kidney failure as in that circumstance the kidney has to absorb water and any fluid of nutritional value. However, the failure to do that leads to blood in urine and even clogging of the urinary tract because of the development of epithelial cells.
Analysis of Symptoms after Administering Medications
The patient did complain of stiffness and pain in their right knee, in addition to being pale, experiencing breathlessness as well as severe vomiting and diarrhea. For that reason, the medications had a bizarre outcome on the patient. Table below indicates the test results after 5-years,
Levels Normal Ranges Normal or Abnormal
Sodium 138 mmol/L 135-145 mmol/L Normal
Potassium 6.7 mmol/L 3.5-5 mmol/L Abnormal
Urea 27 mmol/L 2-6.6 mmol/L Abnormal
Creatinine 360 µmol/L 70.72- 114.92 µmol/L Abnormal
Bicarbonate 18 mmol/L 18-22 mmol/L Normal
pH 7.25 7.35-7.45 Normal
Fasting glucose 11 mmol/L 5.6 to 6.9 mmol/L Abnormal
24-hour urine output 550 ml 800-2000 ml Abnormal
The table clearly reflects the poor state of the patient’s health after a long period of medications treating different ailment in their body. For the analysis of the results, the patient had obvious kidney complications. In addition to that, the prolonged use of medicines such as ramipril has had an acute influence on their deteriorating health status. The patient was likely to have hyperkalemia due to again the long-term use of ramipril that causes an increase in the concentration of potassium ions in the blood stream. Analysis of their urine samples did reveal the following, microscopic urine sediments, and a positive concentration of hemoglobin, strong fractional sodium and a very high urine osmolality of 200mOsm/Kg. The osmolality of the urine though reduces with age because of a number of reasons including diabetes inspidus, glomerulonephritis and even acute renal insufficiency. For that reason, the patient has had a severe reaction to the medications they were administered to hence got even sick and vulnerable to fatal attacks. Analysis of their urine samples did reveal a worse state of the patient’s health as they did acquire ailments that are deadly and were leading in making their health deteriorate.
Healthcare is fundamental to safe living. In most countries, governments put extra attention to insure the good health of their citizens by introducing compulsory health insurance policies to all people. However, regulations that tend to minimize unhealthy living are fought in many states. For instance, there has been an unwavering war against the World Health Organization’s regulations on sugar concentrations in fast foods. Hence, there has been an increase in obesity and cardiovascular complications. Many studies show that the young generations are mostly obese because of unhealthy feeding habits but so does the old populations in many countries of the world. Establishing the right state of health for a patient is, however, paramount to administering the best medications. In most cases, analyzing the patient’s history of diseases, and their current state helps to avoid a recurrence of their deteriorating health in future. For the 62-year-old patient, the case was a complication in that they had multiple ailments whose medications inhibit the curability of the other disease. For that reason, the physician had no options but to put them under all medicines in a bid to reduce any of the diseases from making them vulnerable to fatal incidents. However, the outcomes were devastating a state, which is unfortunate.
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