Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Case Study Discussion 2 (Pharmacology)

Case Study Discussion 2 (Pharmacology)

Pdf Summary

This case study involves a 28-year-old man who was brought in with a gunshot wound to the chest. He was stabilized and showed signs of disorientation, confusion, and agitation. His urine toxicology tests revealed a blood alcohol concentration of 0.2%. The initial question posed in the case study asks about the appropriate analgesia/sedation regimen to initiate. The answer is option C, which involves fentanyl administered as needed intravenously and a propofol infusion. This regimen allows for balanced analgosedation and can be adjusted based on the patient's acute kidney injury (AKI) condition.<br /><br />Over the next two days, the patient's creatinine levels improved, but the agitation only slightly improved. Laboratory findings showed elevated triglyceride (TG) levels and lactate levels. The question asks about what the ICU is observing. The correct answer is option D, which suggests that the patient may be experiencing propofol infusion syndrome (PRIS). This condition is characterized by mitochondrial dysfunction and impaired free fatty acid metabolism and is associated with elevated TG and lactate levels.<br /><br />This case study provides a rationale for the chosen answers and references supporting the management strategies mentioned. It emphasizes the importance of appropriate analgesia/sedation regimens in patients with alcohol withdrawal and the need to consider potential complications such as PRIS in critically ill patients.

Keywords

gunshot wound

chest

alcohol intoxication

analgesia

sedation regimen

fentanyl

propofol infusion

acute kidney injury

propofol infusion syndrome

ICU observation

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