Effectiveness of Magnesium Sulfate †Free Samples to Students

Question: Discuss about the Effectiveness of Magnesium Sulfate. Answer: Introduction Status asthmaticus is a severe form of prolonged asthma attack that makes people fail to respond to usual treatment methods. Asthma is a chronic lung disease where the respiratory airways become narrow and inflamed (Pawankar et al. 2012). The case study reports an incident of acute asthma attack on a patient Ms. Elise Wattle and he treatment upon admission to the emergency department. Asthma is a chronic inflammatory disease associated with the lungs and the airways. It affects more than 300 million people worldwide, belonging to all age groups (Ferkol and Schraufnagel 2014). It develops due to inflammation and swelling of the airways that obstructs airflow and leads to the production of thick and sticky mucus from the airways. The muscles in and around the passage constrict and this in turn reduces the diameter of the airways (Niimi et al. 2013). The most common symptoms of asthma are shortness of breath, wheezing sounds, chest tightness and cough particularly during early morning or at night. These symptoms arise due to airflow obstruction that can be reversed if a patient is subjected to proper treatment. Environmental factors like exposure to several allergens like pollen, dust and dander from dogs and cats increase incidence of asthma. Other irritants that can cause asthma are exhaust fumes from automobiles, chemicals, molds, tobacco smoke, stress and medicat ions like beta blockers and aspirin (Bisgaard, Jensen and Bnnelykke 2012). Elises condition progressed to status asthmaticus. Such acute asthma attacks can occur when the symptoms worsen over time due to bronchospasm or muscle tightening around the airways (Papaiwannou et al. 2014). Thicker mucus will be secreted and the inner lining of the airways will get more inflamed. The symptoms of acute asthma attack are severe wheezing or squeaking sound, continuous coughing, rapid breathing, retractions or tightened chest and neck muscles, difficulty in conversing, anxiety or panic attacks, sweaty face and finger nails turning blue. Airflow limitation occurs due to bronchoconstriction, edema in the airways, hypersecretion of mucus and hyper-responsiveness in bronchi. The symptom related to problems in conversing is demonstrated by the fact that Elise was able to speak in sentences. However, her condition gradually worsened over time and she could barely speak short phrases. The wheezing symptoms are quite audible, which depicts the build-up of mucus in her bronchial tubes. During the acute asthmatic attack, the bronchial airways become smaller. This is responsible for the sounds that were heard when Elise spoke. The dyspnoeic symptoms observed in the patient are due to a deficit formed between breathing demands of her body and the ability of her respiratory system to fulfill the demands. Persistent cough may be the effect of constriction in her breathing tubes. Upon admission to the emergency department, Elise was kept at high Fowlers position to facilitate easy breathing and expansion of her chest cavity. This position allows optimal diaphragm expansion and reduces shortness of breath. However, Elise continued to cough and did not show any improvements. Her blood pressure was found to be 150/90 mm Hg, which indicated stage 1 hypertension (Hoeper et al. 2013). The normal blood pressure in an adult is 120/80 mm Hg. If the readings vary between 140/90-150/99, it signifies that the blood is flowing with a higher force inside the arteries. It can lead to dizziness and will make the patient at an increased risk on the spectrum of cardiovascular diseases (coronary heart disease, stroke, and congestive heart failure), renal failure and vision impairment (Busse et al. 2012). Her pulse was found to be 126 bpm. This pulse rate is considered higher than the normal levels of 60-100 in an adult. Such elevated pulse rates are referred to as tachycardia. It occurs when the heart pumps blood at a faster rate that leads to inefficient circulation of blood to the body parts. When Elise experienced an acute asthmatic attack, there was deficiency of oxygen in her body cells. Her breathlessness made it difficult for the blood to receive enough oxygen. Thus, her heart started to pump rapidly in an effort to meet the oxygen demand and this gave rise to an increased pulse. Psychological factors may also be responsible for this increased pulse rate. An acute asthmatic attack often leads to panic and anxiety. That increases the heart rate and thereby elevates the pulse. Her respiration was shallow and 30. At rest the normal breathing rate in adults is 8-16 per minute. Elise exhibited a high respiratory rate, which is generally denoted by the term tachypnea. Minimal air was drawn into the lungs by the action of intercostal muscles. The asthmatic condition of the patient is the principal reason for this vital sign. Moreover, shortness of breath and rapid pulse elevated her respiration rate (Vestbo et al. 2013). Normal human body temperature is around 37C and Elise did not show much variation (37.3C). This is due to the fact that asthma generally does not lead to chills, fever and muscle ache. Her pulse oximeter readings were 92%. An oxygen saturation level beyond 95% is considered normal. A reduction in her oxygen levels suggested oxygen deficiency in her arterial blood, which occurred as a result of breathing difficulty. Elevated levels of IgE and eosinophils in sputum and blood tests revealed persistent allergy. Allergens are a major cause of asthma . Her high IgE levels indicated that she is exposed to more than one allergy. This proves that hypersensitivity to local allergens and increase in serum IgE are associated with her symptoms of asthmatic attack and wheezing. Several research studies show that an increase in the number of eosinophils, correlate with severity of asthmatic attacks (Korevaar et al. 2015). Eosinophils and neutrophils lead to cellular inflammation of the bronchi passages. When these white blood cells reach the airways, they release chemical contents that cause airway inflammation and blockage of the nasal passage and sinuses. Thus, the increased level of eosinophil in the patient triggered exposure to asthmatic symptoms. Her ABG results showed a pH of 7.49, which is more than the normal range of 7.35-7.45. Her pCO2 is 22 mg Hg ( normal range of 35-45 mm Hg). This suggests likely presence of alkalosis or alkalemia condition in her body due to probable reduction of concentration of hydrogen ions. Her condition suggests respiratory alkalosis that might have occurred due to hyperventilation and may lead to a loss of carbon dioxide. Moreover, the pO2 levels are found to be 74 mm Hg ( normal range of 80-100 mm Hg). This low pO2 level suggests that the lungs are not effective in pulling oxygen gas into the blood stream. This occurred due to her asthmatic attacks that are a form of chronic pulmonary disease. Her HCO3 levels were 22 mEq/L, which shows compliance with the normal range of 22-26 m Eq/L. This does not provide any evidence for the presence of primary metabolic disorders in her system. Normal blood sugar levels range between 4.0-6.0 mmol/L during fasting and upto 7.8 mmol/L, 2 hours post eating. Elises serum glucose levels were 5.0mmol/L, within the normal range that suggests she is non-diabetic. Her blood urea nitrogen levels are 6.2 mmol/L that falls in the normal range of 2.5-7.1 mol/L. Normal serum creatinine levels for women are 45-90 mol/L. Her creatinine levels fall in this range. Thus, it can be deciphered that her liver and kidneys are functioning properly (Brisco et al. 2013). The serum sodium and potassium levels were 136 mEg/L and 4.5 mEg/L that fall within the normal ranges of 135-145 mEg/L and 3.5-5.0 mEg/L respectively. Her normal sodium levels indicate that she is not suffering from hypernatremia or hyponatremia and has normal electrolyte balance in her body (Sahan et al. 2013). Potassium levels within normal range show that her muscles are working properly and there is no occurrence of hyperkalemia condition (Raimondi et al. 2013). Her RBC, WBC and platelet count falls within the normal range of 3.6-5.0 millio/mm3, 5000-10,000/mm3 and 200,000-500,000/mm3 respectively. Normal haematocrit level ranges from 34.9-44.5% for women. A count of 34.7% in Elise shows little deviation which is of little significance. The pulse oximeter reading of 85% provides evidence for supplemental oxygen needs. The pH reading of 7.32 suggests presence of acidosis. pCo2 level of 60 mm Hg indicates respiratory acidosis, which probably occurred due to hypoventilation caused by the asthmatic attacks (Ionescu 2013). For a 10 unit increase in pCO2, the amount of HCO3 rises by 4 mmol/L. Elises HCO3 level of 27 supports this fact. A low pO2 level of 55 mm Hg represents a reduction in the amount of oxygen levels in the inhaled air. It also supports the occurrence of severe pulmonary disease that leads to blockage of the respiratory airways. Abnormalities in lung functioning are detected by spirometry tests that use 2 measurements, FVC (forced vital capacity) and FEV1 (forced expiratory volume one second). The normal range of FEV1/FVC is equal to or more than 70%. A mild abnormali ty of 65% means that the patients lungs are unable to fill air to their normal capacity and are caused due to decrease in the airflow. This has occurred due to the presence of obstructive lung disease. 5 mg salbutamol is administered to the patient through a nebulizer owing to its bronchodilator properties. Salbutamol is a drug that stimulates the 2 adrenergic receptors in the smooth muscles of the bronchi. Upon stimulation, these receptors activate the adenyl cyclase enzyme to form cyclic AMP form ATP. Increased cyclic AMP leads to relaxation of the bronchial smooth muscles and reduces the blockage in airways (Patel et al. 2013). Furthermore, it leads to inhibition of histamine, mast cell and leukotreine release in the airways. Nasal prongs are used to deliver supplemental oxygen to Elise to increase the airflow in her lungs. It will help to deliver oxygen at a concentration of 22-50% flow rate for 1-6 L/min. Magnesium sulphate used in the nebulizer acts as an inhibitor of smooth muscle contraction and reduces the release of histamine and acetylcholine. It therefore functions as a bronchodilator, opens the airways and reduces inflammation of the respiratory passages (Torres et al. 2012). Dose of 500 mcg ipratropium bromide is given to control shortness of breath and wheezing symptoms reported by Elise. This is used in combination with salbutamol to reduce congestion of the respiratory tract and prevent further worsening of symptoms of obstructive pulmonary diseases (Short et al. 2013). Venturi mask was used to deliver specific oxygen concentration in her blood. A 6 hourly administration of hydrocortisone is administered based on its property of reducing inflammation of the bronchial tubes (Short et al. 2012). This is a systemic corticosteroid that controls narrowing of the airways and decreases the amount of mucus formed. Thus, breathing gets facilitated. Administration of adrenaline with 5% dextrose is followed based on their bronchodilator effects. Adrenaline reduces bronchospasms that opens the airways and allows better airflow through the lungs. It also reverses any kind of allergic reaction in the body that may have led to the development of asthma. IV drip of 5% dextrose is given to compensate for the excess loss of water from the lungs (Sellers 2012). Dextrose administration helps in augmenting fluid loss and reduces the tenacity and thickness of the sputum. It helps in adequate hydration of the patient and in restoring the electrolyte balance in the body (Albertson, Sutter and Chan 2015). If salbutamol exceeds the prescribed dose, it can lead to uneven heart beat, hypokalaemia (low potassium levels), muscle cramps, dryness of mouth, headache and dizziness. Potential side effects of magnesium sulphate include hypotension, flushing, anxiety, muscle tightness, dizziness and irregular heart beat (Vasquez et al. 2014). Side effects of ipratropium and hydrocortisone include sedation, dryness of mouth, skin flushing, nausea, glaucoma, tachycardia and palpitations (Coondoo et al. 2014). Administration of ipratropium through a nebulizer often leads to urinary retention among patients. Salbutamol can interact with other bronchodilators and show severe effects on the cardiovascular and nervous system. Dietary components that include caffeine can interact with salbutamol and cause excitability in the patient (Skidmore-Roth 2013). Interaction of the bronchodilators with grilled meat can lead to unmanageable asthmatic attacks. Conclusion Thus, from the above case study it can be deciphered that Elise Wattle suffered from an asthmatic attack following which she was admitted to the hospital. When her condition worsened, the ABG levels showed huge deviations from the normal values indicating that there was less supply of oxygen in her blood stream due to blockage of the airways. 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