A 16-year-old female patient arrives at the Emergency Department after overdosing on medication found in her home. She currently has a Glasgow Coma Scale (GCS) score of 15/15 but is hesitant to disclose what she ingested. According to her mother, it may have been acetazolamide, a carbonic anhydrase inhibitor. As part of her evaluation, a venous blood gas is obtained.
If the patient’s mother is correct, what biochemical abnormality would you anticipate?
You receive a discharge summary for Ms Chen, a 65-year-old lady, who has had an acute surgical admission with pancreatitis. The summary notes that it was thought to be drug-related. Her past medical history includes atrial fibrillation and type 2 diabetes. Her regular medications are ramipril, warfarin, gliclazide, sitagliptin, and simvastatin. She also takes an over-the-counter vitamin C supplement.
Which of her medications might have caused this presentation and should be reported by Yellow Card?
A patient presents to the GP for her annual diabetes check. After discussing her HbA1c results, routine observations are taken as the patient reports experiencing a racing heart lately. She is 65 years old.
Temperature: 36.4ºC
Heart rate: 120 bpm
Respiratory rate: 12bpm
Oxygen saturations: 98% on air
Blood pressure: 135/96 mmHg
The patient’s regular medications include metformin, dapagliflozin, ramipril, nifedipine, and indapamide. Which medication is likely responsible for her symptoms?
A 54-year-old male presents to his general practitioner with a 3-month history of fatigue, polyuria, polydipsia, and recurrent urinary tract infections. He has a medical history of polycystic kidney disease and congestive cardiac failure. Blood tests reveal elevated HbA1c levels and fasting blood glucose levels. What medication should be prescribed to help lower his blood glucose levels, in addition to diet and lifestyle recommendations?
A 65-year-old man from a nursing home was brought in by ambulance to the Emergency Department feeling generally unwell. He was recently treated with amoxicillin for community acquired pneumonia by his GP. The nursing staff said yesterday he was complaining of some muscle pain and weakness and tiredness. He has been vomiting over the last few days. He has a past medical history of asthma, type II diabetes, gout, hypercholesterolaemia and osteoarthritis. Medication includes simvastatin, co-codamol, allopurinol, metformin and a salbutamol inhaler. On examination:
Investigation Result Normal
Respiratory rate (RR) 23 breaths/min 12–18 breaths/min
Sats 96% on air 94–98%
Blood pressure (BP) 126/68 mmHg <120/80 mmHg
Heart rate (HR) 98 beats/min 60–100 beats/min
Temperature 36.8ºC 36.1–37.2°C
He is drowsy but nothing remarkable otherwise. An arterial blood gas (ABG) on air showed:
Investigation Result Normal
pH 7.28 7.35–7.45
pO2 12.0 kPa 10.5–13.5 kPa
pCO2 5.5 kPa 4.7–6.0 kPa
Bicarbonate 18 mmol/l 22–26 mmol/l
BE 1.0 –2 +2
What is the most likely cause of the above presentation and investigation results?
You review a patient on the ward on day two of admission. He is a 16-year-old without medical history; however, his family history reveals that his mother has type II diabetes. The 16-year-old originally presented with a Glasgow Coma Scale (GCS) score of 3/15. The paramedics recorded that the glucose monitor at the scene read ‘LO’ and he was given intravenous dextrose and intramuscular glucagon. On arrival to the Emergency Department, blood glucose was 2.1 and his treatment was continued. He is now euglycaemic off treatment. Blood tests were taken at the time and they have just returned. These tests reveal that:
Serum insulin – raised
C-peptide – raised
What is the most likely cause of this patient’s presentation?
A 26-year-old man presents to the emergency department with a suspected opioid overdose. After prompt treatment, he quickly regains consciousness. This patient has been frequenting the emergency department for the same issue over the past few months. Inpatient treatment for addiction is offered and the patient is admitted to a ward. What is the most suitable medication for this individual?
A young heroin user has been directed to the nearby drugs unit for community-based detoxification. What are the possible heroin substitutes that he may be presented with?
A 70-year-old woman comes to your clinic complaining of ankle swelling. She has started taking a new medication for her blood pressure. She believes that this medication is responsible for her ankle oedema and wants you to investigate. What is the medication most likely to have caused her ankle swelling?
A 32-year-old female patient presents with an overdose of an unknown quantity of an unknown drug, which she took 4 hours earlier. During your assessment, she complains of severe ‘ringing’ in her ears. She has a resting respiratory rate of 24/min. Chest examination is clear.
Which one of the following drugs is she most likely to have taken?