Acid-Base Balance Essay Paper

Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

Your post was very detailed and insightful. I agree and was impressed by your explanation of why the patient presented with the symptoms and the physiologic response to the stimulus presented in the scenario. Naloxone is an opioid antagonist. Therefore, it is used to reverse the effects of opioids particularly in patients who overdose and experience respiratory depression (Fox et al., 2018). The latter remains one of the most significant hazards of using opioids with high fatal outcomes. Acid-Base Balance Essay Paper.The μ-opioid receptors mediate opioid-associated respiratory depression. Respiratory depression usually invokes an involuntary decrease in the rate of respiration and in very severe cases it affects the oxygen saturation levels (Montandon & Slutsky, 2019). It is for this reason that most patients with respiratory depression due to opioid overdoses have very low levels of oxygen saturation and a decreased respiratory rate.

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Necrosis is a sign of cellular death that occurs due to a lack of blood and oxygen in tissues and triggered by factors such as injury, a chronic illness, chemicals, or radiation. In this patient’s case, the most definite cause was a cellular injury caused by tissue hypoxia from restriction in the circulatory system (Fox et al., 2018). This process involves ATP depletion, damage to the mitochondria, an influx of calcium in cells, destruction of the permeability of membranes, and damage to proteins and DNA. These processes cause anaerobic metabolism resulting in acidosis, destruction of the Na/K ATPase pump, and subsequent hyperkalemia, which refers to elevated levels pf potassium in blood (Simon, Hashmi & Farrell, 2019). The elevated potassium levels were the major cause of prolonged PR intervals and peaked T waves in the EKG. Acid-Base Balance Essay Paper.

References

Fox, L. M., Hoffman, R. S., Vlahov, D., & Manini, A. F. (2018). Risk factors for severe respiratory depression from a prescription opioid overdose. Addiction, 113(1), 59-66.

Montandon, G., & Slutsky, A. S. (2019). Solving the opioid crisis: respiratory depression by opioids as critical end point. Chest, 156(4), 653-658.

Simon, L. V., Hashmi, M. F., & Farrell, M. W. (2019). Hyperkalemia. In StatPearls [Internet]. StatPearls Publishing.

In this patient, it is particularly right to conclude that epigenetics plays a huge role in substance abuse. This may occur when environmental exposure alters an individual’s DNA to increase their survival and adaptation. Substance abuse can alter a person’s DNA causing an increase in the production of a protein that plays a key role in influencing repetitive exposure to a drug, which influences long-term changes in the CNS system, which influence drug seeking and use patterns resulting to addiction (Genetics & Epigenetics of Addiction DrugFacts, 2020).

I agree with your explanation on the reasons the patient presented with the symptoms described since the cellular injury and hypoxia causes anaerobic metabolism with subsequent acidosis, reduced ATP, and an overload of calcium in the cellular space, which destroys the potential of the mitochondrial membrane and chain of electron transport (Viera & Wouk, 2015). When there is depletion of ATP, the Na+/K+ ATPase pump is destroyed causing the accumulation of Na+ in intracellular space and overflow of K+ in extracellular space resulting in hyperkalemia. Acid-Base Balance Essay Paper.

To add to your explanation of the physiologic response to the stimulus, it is undeniable that the patient was unresponsive due to an opioid overdose, which causes loss of consciousness. Mu opioid receptor agonists increase the dopamine levels in the central, gastric, and peripheral nervous systems. According to Laycock & Bantel (2019), an increase in the dopamine levels results in sedation, analgesia, dysmotility of the GIT tract, euphoria, decreases the breathing stimulus, decreased respiratory response, and apnea.

References

Genetics and Epigenetics of Addiction DrugFacts. (2020). National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction

Laycock, H., & Bantel, C. (2019). Opioid mechanisms and opioid drugs. Anaesthesia & Intensive Care Medicine. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mpaic.2019.05.009

Viera, A. J., & Wouk, N. (2015). Potassium Disorders: Hypokalemia and Hyperkalemia. American Family Physician, 92(6), 487–495.

Your post was very detailed and insightful. I agree and was impressed by your explanation of why the patient presented with the symptoms and the physiologic response to the stimulus presented in the scenario. Naloxone is an opioid antagonist. Therefore, it is used to reverse the effects of opioids particularly in patients who overdose and experience respiratory depression (Fox et al., 2018). The latter remains one of the most significant hazards of using opioids with high fatal outcomes. The μ-opioid receptors mediate opioid-associated respiratory depression. Respiratory depression usually invokes an involuntary decrease in the rate of respiration an in very severe cases it affects the oxygen saturation levels. It is for this reason that most patients with respiratory depression due to opioid overdoses have very low levels of oxygen saturation and a decreased respiratory rate.

Necrosis is a sign of cellular death that occurs due to a lack of blood and oxygen in tissues and triggered by factors such as injury, a chronic illness, chemicals, or radiation. In this patient’s case, the most definite cause was a cellular injury caused by tissue hypoxia from circulatory restriction (Fox et al., 2018). This process involves ATP depletion, damage to the mitochondria, an influx of calcium in cells, destruction of the permeability of membranes, and damage to proteins and DNA. These processes cause anaerobic metabolism resulting in acidosis, destruction of the Na/K ATPase pump, and subsequent hyperkalemia. The elevated potassium levels were the major cause of prolonged PR intervals and peaked T waves in the EKG. Acid-Base Balance Essay Paper.

References

Fox, L. M., Hoffman, R. S., Vlahov, D., & Manini, A. F. (2018). Risk factors for severe respiratory depression from a prescription opioid overdose. Addiction, 113(1), 59-66.

JUBY THOMAS 

RE: Discussion – Week 1

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The role genetics plays in the disease.

A genetic predisposition is an increased likelihood of developing a particular disease based on a person’s genetic characteristics and is often inherited from a parent. According to McCance & Huether (2019a), genetic diseases caused by single genes usually autosomal dominant, autosomal recessive, and x-linked recessive mode of inheritance.

Why the patient is presenting with the specific symptoms described?

Patient was found unresponsive and have a history of substance abuse. The patient became conscious after the administration of naloxone, which is the antagonist for opioid overdose. During the Evaluation in the emergency department (ED) a large amount of necrotic tissue over the greater trochanter as well as the forearm. Necrosis is characterized by rapid loss of plasma membrane structure organelle swelling mitochondrial dysfunction and the lack of typical features of apoptosis (McCance & Huether, 2019b). The patient was presented with pain, which is one of the systemic manifestations of cellular injury caused by various mechanisms like the release of bradykinins, obstruction, and pressure (McCance & Huether, 2019b). In hypoxic injury, the movement of fluid and ions into the cell is associated with acute failure of metabolism and loss of ATP production. In metabolic failure caused by hypoxia reduced level of ATP and ATPase permit sodium accumulates in cells, whereas potassium diffuses outward (McCance & Huether, 2019b). Cellular injury can release large quantities of intracellular potassium into the extracellular space.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

Large amount of necrotic tissue over the greater trochanter as well as the forearm found on the patient during evaluation in ED. Injection drug use is a common cause of skin and soft-tissue infections with both gram-positive skin flora and gram-negative enteric flora, dependent on the materials used to process and use the drug (Wurcel et al., 2015). Bacterial growth within the superficial fascia releases a mixture of enzymes and endo- and exotoxins causing the spread of infection through this fascia. This process results in poor microcirculation, ischemia in affected tissues, and ultimately, cell death and necrosis (Davoudian & Flint, 2012).Acid-Base Balance Essay Paper.  Thrombosis of small veins and arteries passing through the fascia causes profound skin ischemia. This skin ischemia is the fundamental process for the soft tissue presentation of necrotizing fasciitis (Davoudian & Flint, 2012).

The cells that are involved in this process.

Cells and tissues involved in the process of necrotizing fasciitis are epidermis and dermis, which includes superficial fascia, subcutaneous tissue, subcutaneous fat, nerves, arteries, veins, deep fascia and sometimes muscles (Davoudian & Flint, 2012).

How another characteristic (e.g., gender, genetics) would change your response?

Most of the cases of necrotizing fasciitis occurred in men aged ⩾40 years; most of the patients were white or Hispanic (Chen et al., 2001).

References

Chen, J. L., Fullerton, K. E., Flynn, N. M. (2001). Necrotizing Fasciitis Associated with Injection Drug Use, Clinical Infectious Diseases, 33(1), 6–15. https://doi.org/10.1086/320874

Davoudian, P & Flint, N. J. (2012). Necrotizing fasciitis, Continuing Education in Anaesthesia Critical Care & Pain,12(5), 245–250. https://doi.org/10.1093/bjaceaccp/mks033

McCance, K. L. & Huether, S. E. (2019a). Genes and Genetical Diseases. In V.L. Brashers & N.S. Rote (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed.) (pp. 149) St. Louis, MO: Mosby/Elsevier

McCance, K. L. & Huether, S. E. (2019b). Altered Cellular and Tissue Biology: Environmental Agents. In V.L. Brashers & N.S. Rote (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed.) (pp. 84-88) St. Louis, MO: Mosby/Elsevier

Wurcel, A. G., Merchant, E. A., Clark, R. P., & Stone, D. R. (2015). Emerging and Underrecognized Complications of Illicit Drug Use. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 61(12), 1840–1849. https://doi.org/10.1093/cid/civ689

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Jacqueline K.
RE: WK 1 Discussion

The Role of Genetics Plays in the Disease
Patient history of substance abuse is associated with epigenetics. Environmental exposure can alter the DNA to increasing adaptation and survival. The epigenetic changes’ effects can determine an individual’s health and the traits passed through generations. Substance abuse can lead to a DNA alteration leading to an increase in the production of the proteins involved in addiction, causing drug-seeking behaviors in animals (Genetics and Epigenetics of Addiction Drug Facts, 2020).
Why the Patient is Presenting with the Specific Symptoms Described
Unresponsive related to drug overdose reported in the patient’s history of substance abuse. The patient became responsive after the administration of Naloxone, which is a competitive antagonist of the opiate receptor (Schiller, Goyal, Coa, Mechanic,2020). The patient complained of burning pain over his left hip and forearm because the analgesic effects of the opioid were deactivated by Naloxone (Schiller, Goyal, Cao, Mechanic,2020).
Opiate is a derivative from the opium poppy plant. Opioid receptors are found in the gastric, central, and peripheral nervous system. Opioid overdose triad is associated with pinpoint pupils, respiratory depression, and a decreased level of consciousness. The central opioid receptors are mu, kappa, and delta. Kappa receptors control analgesia, diuresis, miosis, and dysphoria. Delta receptors control analgesia, cough suppression, euphoria, and seizures (Schiller, Goyal, Cao, Mechanic, 2020)
Pain is a systemic manifestation of cellular damage, which in this situation can be because of the release of bradykinins by the tissues surrounding the necrotic cells. The mu receptor agonist leads to increased dopamine resulting to analgesia and euphoria, sedation, respiratory depression, gastrointestinal dysmotility, physical dependence, medullary diminished response to hypercarbia, decrease in the respiratory response to hypoxia, reducing the breathing stimulus to leading to apnea(Schiller, Goyal, Cao, Mechanic, 2020). The depolarization action of the terminal nerve Calcium channels and increase of Potassium current to decrease the repolarization time and the duration of the action potential leads to opioid analgesic (Laycock & Bantel, 2019). Acid-Base Balance Essay Paper.

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A large amount of necrotic tissue over the greater trochanter as well as the forearm was because of cellular injury, which could have been due to tissue hypoxia after a prolonged circulatory restriction from the lying unresponsive on the left side, pathogenic organism infection, or chemical toxicity from contaminated needles or toxic substance on the tissue. The process of cell damage involves depletion of ATP, Mitochondrial Damage, Influx of intracellular Calcium and loss of Calcium Homeostasis, Accumulation of Oxygen Derived Free Radicals (Oxidative Stress), Defects in Membrane Permeability, and finally, Damage to DNA and Proteins. Cellular hypoxia leads to anaerobic metabolism, leading to acidosis, decreased ATP, and cellular calcium overload. The mitochondrial permeability transition pore (mPTP), mitochondrial membrane potential, and electron transport chain are destroyed. The depletion of ATP destroys the Na+/K+-ATPase pump causing intracellular Na+ accumulation and extracellular K+ overflow leading to hyperkalemia (Wetzel, & Wenke, 2019).
Prolonged PR interval and peaked T waves result from a Serum potassium level of 6.9 mEq/L revealed hyperkalemia. Normal potassium levels being [3.6–5.0]. Hyperkalemia is defined as a potassium level > 5.5 mEq/L. Moderate hyperkalemia is a serum potassium > 6.0 mEq/L, Severe hyperkalemia is a serum potassium > 7.0 mE/L. Potassium is involved in regulating cardiac muscle electrical conduction. Increased extracellular potassium reduces myocardial excitability. Hyperkalemia is associated with repolarization abnormalities. Peaked T waves is an initial sign of hyperkalemia. Serum potassium higher than 6.5 mEq/L is associated with progressive paralysis of the atria, P wave widens, and flattens or disappear and lengthened PR segment (Viera & Wouk, 2015).
The Physiologic Response to the Stimulus Presented in the Scenario and Why the Response Occurred
The patient was found unresponsive due to opioid overdose, which leads to loss of consciousness. Opioid leads to the mu receptor agonist increasing the levels of dopamine in the gastric, central, and peripheral nervous system. Increased dopamine causes analgesia and euphoria, sedation, respiratory depression, gastrointestinal dysmotility, medulla decrease response to hypercarbia, decrease respiratory response to hypoxia, reduced breathing stimulus, and consequently, apnea (Schiller, Goyal, Cao, Mechanic, 2020).
A large amount of necrotic tissue over the left greater trochanter, as well as the left forearm, possibly related to ischemia and trauma from a fall sustained in loss of consciousness. Pathogenic infection or chemical toxicity from infected needles or substance could also have caused the tissue necrosis.
Serum potassium of 6.9mEq/L revealed hyperkalemia from the overflow of intracellular potassium into the interstitial fluid because of Na+/K+-ATPase pump damage to tissue damage that resulted in the necrosis. Hyperkalemia resulted in the prolonged PR interval and peaked T waves. Hyperkalemia decreases myocardial excitability and reduces the pacemaking and conducting tissues of the heart. The impulse generating SA nodes, the conduction of the AV nodes, and the His-Purkinje system are blocked in Increased hyperkalemia, resulting in bradycardia, conduction blocks, and ultimately cardiac arrest (Viera & Wouk, 2015).
The Cells that are Involved in this Process
The process of cell damage involves depletion of ATP, Mitochondrial Damage, Influx of intracellular Calcium and loss of Calcium Homeostasis, Accumulation of Oxygen Derived Free Radicals (Oxidative Stress), Defects in Membrane Permeability, and finally, Damage to DNA and Proteins. Cellular hypoxia leads to anaerobic metabolism, leading to acidosis, decreased ATP, and cellular calcium overload. The mitochondrial permeability transition pore (mPTP), mitochondrial membrane potential, and electron transport chain are destroyed. The depletion of ATP destroys the Na+/K+-ATPase pump causing intracellular Na+ accumulation and extracellular K+ overflow leading to hyperkalemia (Wetzel, & Wenke, 2019).
Serum potassium of 6.9mEq/L revealed hyperkalemia from the overflow of intracellular potassium into the interstitial fluid because of Na+/K+-ATPase pump damage to tissue damage that resulted in the necrosis. Hyperkalemia resulted in the prolonged PR interval and peaked T waves. Hyperkalemia decreases myocardial excitability and reduces the pace of making and conducting tissues of the heart. The impulse generating SA nodes, the conduction of the AV nodes, and the His-Purkinje system are blocked in Increased hyperkalemia, resulting in bradycardia, conduction blocks, and ultimately cardiac arrest ((Viera & Wouk, 2015).
How Another Characteristic (e.g., Gender, Genetics) Would Change the Response. Acid-Base Balance Essay Paper.
Individuals’ genes in complex interactions, together with environmental influences, may increase the risks of acquiring some diseases. The World Health Organization reported a high genetic or epigenetic predisposition to some comorbidities, like cancer, diabetes, cardiovascular disease, asthma, and mental illnesses. For example, the disease manifestation of cardiovascular disease can is specific amongst different communities. African communities suffer ischemic attacks related to cardiovascular disorders, while south Asians develop cardiac arrest (Genes and human diseases 2020).
Reference
Genes and human diseases (2020). World Health Organization. https://www.who.int/genomics/public/geneticdiseases/en/index3.htm
Genetics and Epigenetics of Addiction DrugFacts. (2020). National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction.
Laycock, H., & Bantel, C. (2019). Opioid mechanisms and opioid drugs. Anaesthesia & Intensive Care Medicine. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mpaic.2019.05.009
Schiller E. Y, Goyal A, Cao F, Mechanic O.J. (2020). Opioid Overdose. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK470415
Viera, A. J., & Wouk, N. (2015). Potassium Disorders: Hypokalemia and Hyperkalemia. American Family Physician, 92(6), 487–495.
Wetzel, M. D., & Wenke, J. C. (2019). Mechanisms by which hydrogen sulfide attenuates muscle function following ischemia-reperfusion injury: effects on Akt signaling, mitochondrial function, and apoptosis. Journal of Translational Medicine, 17(1), 33. https://doi-org.ezp.waldenulibrary.org/10.1186/s12967-018-1753-7. Acid-Base Balance Essay Paper.