Alterations In Cellular Processes NURS 6501
Alterations In Cellular Processes NURS 6501
Alterations In Cellular Processes NURS 6501
This paper is a case study involving a 27-year-old patient with a history of substance abuse who is found unresponsive by emergency medical services. The patient becomes responsive after being administered naloxone. The essay examines the role of genetics, reasons for patient’s symptoms, physiological response, cells involved, and influence of other characteristics.
Genetics play a role in substance use disorders. For example, opioid use disorder has large risk of being inherited in families. Genes such as OPRM1 variates and A118G also predispose individuals to substance abuse disorder. Individuals of European descent with OPRD1 genes also have high predisposition to opioid use disorder. Additional genes include KCNG2, CNHIH3, KCNC1, RGMA, and APBB2 genes (Crist et al., 2019; Liu et al., 2019).
The patient presented with symptoms such as unresponsiveness due to central nervous system depression by the opiate overdose. The patient became response following the administration of naloxone since its an opiate antagonist that reverses the depressing effects of opiates. The patient reported pain in left hip and forearm because the effects of the opiates had ben reversed, hence, perception of pain. There is also tissue necrosis that may have developed due to poor tissue perfusion from depressed central nervous system, which affected circulation and respiratory system (Parthvi et al., 2019). The patient also developed respiratory acidosis, which increased serum potassium, hence, hyperkalemia and ECG changes.
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The cells involved in the patient’s symptoms include mast cells, neutrophils, and macrophages. These cells induce the induction and transition of the pain the patient experience. Adaptive immune cells such as B and T cells also initiate and resolve pain. Characteristics such as age would change my response in this case study (Machelska & Celik, 2020). For example, the elderly patients have low sensitivity to pain stimuli and potentially worse outcomes due to opiate overdose. These changes will affect the treatment interventions.
In summary, substance abuse has genetic predisposition. The patient developed the given symptoms because of the effects of opioid overdose and naloxone. Age would affect the clinical symptoms and management of opiate overdose.
References
Crist, R. C., Reiner, B. C., & Berrettini, W. H. (2019). A review of opioid addiction genetics. Current Opinion in Psychology, 27, 31–35. https://doi.org/10.1016/j.copsyc.2018.07.014
Liu, M., Jiang, Y., Wedow, R., Li, Y., Brazel, D. M., Chen, F., Datta, G., Davila-Velderrain, J., McGuire, D., Tian, C., Zhan, X., Choquet, H., Docherty, A. R., Faul, J. D., Foerster, J. R., Fritsche, L. G., Gabrielsen, M. E., Gordon, S. D., Haessler, J., … Vrieze, S. (2019). Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. Nature Genetics, 51(2), Article 2. https://doi.org/10.1038/s41588-018-0307-5
Machelska, H., & Celik, M. Ö. (2020). Opioid Receptors in Immune and Glial Cells—Implications for Pain Control. Frontiers in Immunology, 11. https://www.frontiersin.org/articles/10.3389/fimmu.2020.00300
Parthvi, R., Agrawal, A., Khanijo, S., Tsegaye, A., & Talwar, A. (2019). Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit. American Journal of Therapeutics, 26(3), e380. https://doi.org/10.1097/MJT.0000000000000681
In this week’s case study, the patient presents with a chief complaint of a sore throat and multiple other symptoms that resulted in a positive strep test. Strep throat, also known as bacterial pharyngitis, is caused by the presence of Streptococcus group A bacteria that is spread by respiratory droplets and is the most common cause of pharyngitis in children (Chauhan, et al., 2016). In a recent meta-analysis, 37% of children less than 18 years old were diagnosed with Group A Strep and presented to an outpatient center for treatment for a sore throat in comparison to only 15% of adults (Ashurst & Edgerley-Gibb, 2022).
The patient presented with a sore throat, reddened posterior pharynx with white exudate, and 3+ tonsils- all due to the presence and colonization of the streptococcus bacteria. The positive sign of anterior and posterior cervical adenopathy is due to the infection and the body’s response to try and fight the infection. The patient was prescribed ten days’ worth of amoxicillin and after consumption, immediately experienced swelling of the tongue and lips, difficulty breathing, and wheezing. The patient was having an anaphylaxis reaction to the antibiotics. An anaphylaxis response is IgE mediated and results in mast cells releasing a large amount of histamine and leukotrienes that cause bronchospasm and edema (Vaillant, Vashisht, & Zito, 2022).
Even after antibiotic treatment, some children get recurrent strep throat due to a genetic basis. A study performed by Dr. Shane Crotty and Dr. Jennifer Dan (2019), explored the germinal centers of both children with a normal rate of infection and those with recurrent tonsillitis. Their findings suggested that children with recurring strep throat had smaller germinal centers with fewer B and helper T cells which are responsible for producing antibodies and fighting invading pathogens. Upon further research, it was discovered that the genetic component was identified as two variants in the HLA genomic region which are associated with increased susceptibility to recurrent tonsillitis as well as protecting against the disease. If a child presented with recurring group A streptococcus pharyngitis, it may warrant a different response than treating with just antibiotics, such as referring them to an ENT for a tonsillectomy.
References
Ashurst, J. V., & Edgerley-Gibb, L. (2022). Streptococcal Pharyngitis. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525997/
Chauhan, S., Kashyap, N., Kanga, A., Thakur, K., Sood, A., & Chandel, L. (2016). Genetic diversity among group A streptococcus isolated from throats of healthy and symptomatic children. Journal of Tropical Pediatrics, 62(2), 152-157. doi:10.1093/tropej/fmv092
Crotty, S., & Dan, J. (2019). Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine, 11(478). doi:DOI: 10.1126/scitranslmed.aau3776
Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions. StatPearls. doi:https://www.ncbi.nlm.nih.gov/books/NBK513315/
Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
To prepare:
- By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
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
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
I agree that genetics does play a role in opioid addiction and substance abuse. “Family studies that include identical twins, fraternal twins, adoptees, and siblings suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup” (National Institute on Drug Abuse, n.d.). Variations in genes contribute to predisposition to drug addiction (National Institute on Drug Abuse, n.d.). Opioid addiction can cause several health-related uses, including Rhabdomyolysis (Adrish, Duncalf, Diaz-Fuentes, & Venkatram, 2014). However, one cannot inherit Rhabdomyolysis (Adrish, Duncalf, Diaz-Fuentes, & Venkatram, 2014). Simply put, It is a condition that causes the breakdown of muscles; however, for this post, your definition is more detailed.
In your assigned scenario, the patient with the following: had a large amount of necrotic tissue over the greater trochanter and the forearm, Prolonged PR interval and peaked T waves on his EKG, and an elevated serum potassium level of 6.9. In your post, you wrote that the patient’s necrosis could have occurred due to prolonged immobilization and compartment syndrome. Since the event wasn’t witnessed, I would suggest that the patient’s reaction drug of choice caused the Rhabdomyolysis. He Rhabdomyolysis typically manifests in one to three days after a muscle injury but has been known to be very “severe when precipitated by drug overdoses compared to other etiologies” (Adrish, Duncalf, Diaz-Fuentes, & Venkatram, 2014) (Cleveland Clinic, 2023). I agree that the potassium is elevated due to the Rhabdomyolysis, and the prolonged PR interval and peaked T waves were caused by the elevated potassium. The patient’s loss of consciousness could result from a drug overdose or symptom of Rhabdomyolysis.
Lastly, I agree that an older patient is at a higher risk for accidental overdose and falls. Other risk factors for Rhabdomyolysis in a more aging population include extended periods of inactivity; certain medical conditions; severe dehydration, and certain medications (antipsychotic, antidepressant, antiviral diabetic, and statins) (Cleveland Clinic, 2023). Thank you for your post.
Case Study Discussion
“The role genetics plays in the disease.”
Individuals with the essential condition known as rhabdomyolysis are prone to developing because of the enzyme phospholipids. Some of these include Duchenne muscular dystrophy and other genetic disorders. Although genetics play a role in the development of rhabdomyolysis, it is not the cause. Instead, it is the compression of muscles caused by substance abuse and immobility.
“Why the patient is presenting with the specific symptoms described.”
The damage to the muscles in the hip caused by Rhabdomyolysis is one of the reasons why the patient was experiencing burning pain in their hip. The inflammation and destruction of the muscle tissues caused by the leakage of plasminogen and thromboplastin can lead to vascular obstruction and necrosis. This condition can cause burning pain over the forearm. The high potassium level people experience due to this condition can be attributed to potassium leakage into the circulation. (McCance & Huether, 2019b)
“The physiologic response to the stimulus presented in the scenario and why you think this response occurred.”
Naloxone reverses opioid overdoses by blocking the opioid receptors in the CNS, thus reducing or eliminating the depressant effects of opioids. It is an antidote used clinically to treat respiratory depression caused by overdose or poisoning due to opioids (Johansson et al., 2019). Most of the drugs that are abused can affect the skeletal muscles. This can lead to Rhabdomyolysis. The patient’s condition shows that he or she was lying down at an unknown time, which might have caused the pressure in specific muscle compartments to rise. These include the hip, gluteal, and leg muscles.
“The cells that are involved in this process”
The cells involved in this process are the neurons within the central nervous system. The neurons most commonly affected by opioid overdoses and overdoses associated with substance abuse are located in the locus coeruleus, a part of the brain stem and spinal cord (Daga et al., 2019). The damage to muscle cells is the leading cause of this process. Myoglobin then leaks into the blood, which can cause renal toxicity. In addition, muscle ischemia can lead to nerve damage and fluid shift resulting from hypovolemia. Also, hyperkalemia can cause dysrhythmias.
“How another characteristic (e.g., gender, genetics) would change your response”
Individuals suffering from genetic disorders such as McArdle disease or those with missing or deficient enzymes are more prone to experiencing Rhabdomyolysis. However, this condition is not caused by congenital defects. Instead, it is a result of substance abuse and immobility. Differences in gender and genetics may affect a patient’s physiologic response to opioids. Research shows that women are more sensitive to the effects of opioids than men due to their smaller body size and differences in opioid receptors (Wang et al., 2019). Women and men with the mu-opioid receptor gene produce less of them, making them physically dependent on opioids faster than their non-carriers.
References
Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid addiction, genetic susceptibility, and medical treatments: a review. International journal of molecular sciences, 20(17), 4294.
Daga, M. K., Kumar, L., & Shukla, J. (2019). Central nervous system depressants: overdose and management. Princ Pract Crit Care Toxicol, 77.
McCance, K. L. & Huether, S. E. (2019a). Alterations of Musculoskeletal Function. In V. Brashers & N. Rote. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed.). (pp. 1430-1432). St. Louis, MO: Mosby/Elsevier.
Johansson, J., Hirvonen, J., Lovró, Z., Ekblad, L., Kaasinen, V., Rajasilta, O., … & Scheinin, M. (2019). Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects. Neuropsychopharmacology, 44(9), 1667-1673
Collapse Subdiscussion Frank Uche Akpati
Thank you so much! Extensive tissue necrosis or rhabdomyolysis from overdose are the likely cause of the hyperkalemia in this patient. An elevated serum creatine kinase is the most sensitive and reliable indicator of muscle injury. The degree of elevation correlates with the amount of muscle injury and the severity of symptoms, but not the development of acute kidney injury or other morbidity. Most authors consider a fivefold or greater increase above the upper threshold of normal in serum creatine kinase level, in the absence of cardiac or brain injury, as the requirement for the diagnosis of rhabdomyolysis (approximately 800 to 1000 IU/L).
Nice reading your detailed post. I completely agree with you when you say genetics has no role in this particular scenario. While lots of information are missing, it is clear that the person overdosed a certain narcotic. This is the case because he was responsive to naloxone/Narcan. Eventually, he became unconscious and was found lying over something after a prolonged period of time as evidenced by the necrotic tissues on the greater trochanter and forearms. Those muscles on the greater trochanter area and forearms became necrotic because there was not enough circulation to the tissues. The person was primarily lying on these pressure points. That is why they became necrotic and painful.
Consequently, with a lot of cell death in the areas of necrosis, the inside contents of the dead cells are discharged into the bloodstream. Potassium is one of the cations found inside the cell in high concentration. Hence, the blood potassium level is elevated to 6.9. Therefore, the patient is hyperkalemic and has prolonged PR interval and peaked T waves in his EKG. Another possible reason for the hyperkalemia besides the cell death may be acute kidney injury possibly because of the nephrotoxic effects of the opiates, dehydration, and inadequate perfusion.
Lastly, men and women of all races are equally affected by drug overdose. The amount of opiate that makes a person unconscious may differ according to body weight, opiate tolerance, and gender. But once any person gets enough dose to make him/ her unconscious, he/ she is going to display the same disease process. The treatment approach is again similar. The first step would be administrating naloxone and establishing at least two good IV accesses for IV push medications and fluids. Eventually, labs including BMP, CBC, and CK/ CPK are drawn. It is also great to check his urine for drugs and AKI. Next, the patient is given fluids to get rid of the excess potassium, creatinine, and urea nitrogen in the blood provided the patient is able to make urine. If the patient is unable to make urine, hemodialysis is recommended.
References
Loscalzo J. (2010). The cellular response to hypoxia: tuning the system with microRNAs. The Journal of clinical investigation, 120(11), 3815–3817. https://doi.org/10.1172/JCI45105
Petejova, N., & Martinek, A. (2014). Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Critical care (London, England), 18(3), 224. https://doi.org/10.1186/cc13897
Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2022 Oct 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470284/
Singh, V. P., Singh, N., & Jaggi, A. S. (2013). A review on renal toxicity profile of common abusive drugs. The Korean journal of physiology & pharmacology : official journal of the Korean Physiological Society and the Korean Society of Pharmacology, 17(4), 347–357. https://doi.org/10.4196/kjpp.2013.17.4.347
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Great post,
Thanks for the information on McArdle’s disease. Researchers (Khattak ZE, 2000) explain that McArdle disease is a genetic disorder mainly affecting skeletal muscles. It occurs due to the deficiency or absence of an enzyme called myophosphorylase. Symptoms like painful muscle cramps, weakness, and fatigue manifest during periods of physical activity. Clients with this disease experience the same symptoms as those in the scenario but without signs of infection or physical activity. Clients with McArdle disease cannot break down glycogen into glucose. This inherited disease has no cure, but symptoms can be managed. According to (Satoh et al., 2019), you can use specific diet and exercise strategies to help control the problem. A well-designed low or moderate-exercise routine may help your body get the most out of your ability to use glucose. Overdoing exercise can harm the muscles and kidneys in people with McArdle disease. Again, thanks for prompting me to engage in some research about this genetic disorder. It was well worth it.
References
Khattak ZE, M. (2000, May). McArdle Disease. StatPearls. Retrieved March 2, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK560785/
Satoh, A., Hirashio, S., Arima, T., Yamada, Y., Irifuku, T., Ishibashi, H., Motoda, A., Sueda, Y., & Masaki, T. (2019). Novel Asp511Thr mutation in McArdle disease with acute kidney injury caused by rhabdomyolysis. CEN Case Reports, 8(3), 194–199. https://doi.org/10.1007/s13730-019-00392-6
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Good post. The manifestation of rhabdomyolysis or hyperkalemia during an opiate overdose is not associated with genetics. Nevertheless, certain genetic conditions, including metabolic myopathies (McArdle disease), muscular dystrophies, and channelopathies, can make an individual more susceptible to rhabdomyolysis (Nance & Mammen, 2015). But if the patient were of the female gender, there would be additional factors to consider. Co-occurring psychological and social disorders commonly accompany substance abuse diagnoses in females. These disorders include eating, mood, anxiety, and post-traumatic stress disorders (Greenfield et al., 2010). Apart from diagnosing and treating the specific medical issue that led to the hospitalization, I would also address these mental health-related concerns and the sexual health of the patient and her partner(s).
References:
Nance, J. R., & Mammen, A. L. (2015). Diagnostic evaluation of rhabdomyolysis Muscle &Nerve,51(6), 793-810. https://doi.org/10.1002/mus.24606
Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. Psychiatric Clinics of North America,33(2), 339-355. https://doi.org/10.1016/j.psc.2010.01.004
Mar 3, 2023 Mar 3 at 5:52am
Response # 1
Thank you so much for sharing such a well-written post; it was interesting to read.
Indeed, Rhabdomyolysis is a perilous disease; like you stated, as much as genetics may play a role in some processes but not the cause of the disease. Rhabdomyolysis is usually caused by extended heat exposure, physical exertion, and direct trauma, such as a crush injury from a fall. And all this may cause muscle damage, leading to electrolyte deposits and muscle proteins like creatine kinase (CK) and creatine phosphokinase (CPK). These deposits can cause damage to muscles and some vital organs like the heart and kidney, which may lead to permanent damage (CDC, 2023). And I believe the burning sensation in their patient’s hip was from the damaged muscles.
The physiologic response to the stimulus presented in the scenario and why this response occurred. Since Naloxone was in the picture and its use brought about positive results, this confirms that there was an element of substance abuse. It was also noted that prolonged substance abuse could affect skeletal muscles, resulting from many variables like nutritional issues, effects of the drugs, posture presentations, and the effects of substance withdrawals (American Addiction Centers, 2022). But in this scenario, the patient was lying in the same position for an unknown time. And because of the pressure on the affected parts of the body, blood circulation must have been cut off, which brought about muscle breakdown leading to Rhabdomyolysis.
Once again, thank you so much, Gifty, for a beautiful post.
References.
Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH). February 8th, 2023.Rhabdomyolysis. Retrieved from https://www.cdc.gov/niosh/topics/rhabdo/default.html#:~:text=Rhabdomyolysis%20(often%20called%20rhabdo)%20is,permanent%20disability%20or%20even%20death
American Addiction Centers. How drugs and alcohol affect the skeletal system. November 10th, 2022. Retrieved from https://americanaddictioncenters.org/health-complications-addiction/skeletal-system
Collapse Subdiscussion Minu Bijo Philip
Thank you for your informative discussion on the clinical case of a patient who had an opioid overdose and rhabdomyolysis. The discussion was well structured, and answered all the questions appropriately. Genetics influences the risk of rhabdomyolysis, especially in individuals with muscular disorders such as Duchenne muscular dystrophy. The patient was experiencing burning pain in his hip because he had rhabdomyolysis and necrosis of the muscular tissue. Necrosis destroys the cell membrane, triggers inflammation, and irritates the nerves causing pain (Lee & Neumeister, 2020). The patient also experienced pain because naltrexone reversed the analgesic effects of opioids. The patient was unconscious because opioids cause depression in the central nervous system (van-Draanen et al., 2021). the cells involved in the patient’s pathology are the skeletal muscle cells and the neurons. Patients with genetic disorders such as McArdle disorder are at greater risk of developing rhabdomyolysis due to the deficiency of enzymes. Finally, variations in the types of opioid receptors influence the risk of experiencing the effects of opioid overdose.
References
Lee, G. I., & Neumeister, M. W. (2020). Pain: Pathways and Physiology. Clinics in Plastic Surgery, 47(2), 173–180. https://doi.org/10.1016/j.cps.2019.11.001
van-Draanen, J., Tsang, C., Mitra, S., Phuong, V., Murakami, A., Karamouzian, M., & Richardson, L. (2021). Mental disorder and opioid overdose: a systematic review. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-021-02199-2
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I loved reading your post. Interesting to learn about McArdle disease. It is a disorder that affects the skeletal muscle and can cause painful muscle cramps and weakness. I see the relationship with rhabdomyolysis, but I’m afraid I have to disagree that it could be the cause for it due to a lack of information in the original scenario. Seems like you agree with this conclusion as well.
Your post is well-written and solidified by a lot of research, giving me little room to disagree with your explanation. I am happy to work alongside you in this class, and it seems like I will learn a lot from you.
Collapse Subdiscussion S
Great explanation of your theory about the this particular case study. I agree with your assessment that genetics in this particular situation was not at play, but it was interesting to learn that it can make an individual more susceptible torhabdomyolysis. It was evident in this situation the patient was suffering from an opiate overdose. During this assignment I learned that Opiates act as agonists on the body’s opiate receptors which are in the brain and spinal cord. When these receptors are presented with opiates they release dopamine, which blocks pain, and creates the feeling of a “high” many of its users crave. Another interesting subject I learned about was The Opioid Overdose Triad where the patient will exhibit is pinned pupils, decrease of respirations, and decrease in level of consciousness.
I was initially confused as to how necrotic tissue could of developed so quickly over the greater trochanter and forearm but after learning that Rhabdomyolysis can occur after prolonged immobility and combining the fact that we did not know how long the patient was lying on the limb it made better sense.
When taking a closer look at genetics I found it interesting to learn that certain disorders such as McArdle disease and Tarui disease can increase the possibility of Rhabdomyolysis. In this case study both environmental and genetic factors may be in play making the patient more prone to RM.
References:
A.D.A.M Inc. (1997-2023). Necrosis: MedlinePlus Medical Encyclopedia. Retrieved February
27,2023from https://medlineplus.gov/ency/article/002266.htm#:~:text=Necrosis%20is%20the%20death%20of,injury%2C%20radiation%2C%20or%20chemicals.
Bezrutczyk, D. (2023, February 9). The Differences in Addiction Between Men and Women – Addiction
Center. Addiction Center. Retrieved February 28, 2023, from https://www.addictioncenter.com/addiction/differences-men-women/#:~:text=Furthermore%2C%20women%20develop%20a%20dependence,as%20a%20result%20of%20abuse.
Dhaliwal, A. (2022, July 25). Physiology, Opioid Receptor. StatPearls – NCBI Bookshelf.
Retrieved February 28, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK546642/#:~:text=Opioid%20receptors%20are%20present%20in,bradycardia%2C%20which%20ultimately%20causes%20hypotension
Genetic Science Learning Center. (2013, August 30) Opioids and the Physiology of Tolerance. Retrieved
it is true that cells are the basic structural components of the body and are specialized to conduct different functions in the body. The central dogma also illustrates the pivotal role of genes in dictating the specialization of cells and subsequent events. Disease can alter the nature of cells thereby interfering with the normal cell functions. I find your case analysis quite intriguing, there are many patients who complain of sore throat that is related to allergic conditions and your analysis through genetic involvement is informative (Centers for Disease Control and Prevention,2021).
Group A streptococcus pharyngitis among children and adolescents is common and the identification of the genes associated with the common occurrence provides an avenue for solving the menace. Hypersensitivity relation to genetic composition also provides a better understanding of the recurrence of such cases (McCance & Huether, 2019). I also think that the bod defense system is triggered by recognition of the pathogen and the process of acting against the identified antigen leads to the symptoms, which include inflammation that would be felt as sore throat.
I agree hat the physiological processes upon identification of the antigen includes a variety of cells mediators that take part in the inflammatory pathway. These processes cause heat, swelling and redness. The patient characteristics that define different responses include age as age relates to immunity. Children are more susceptible to some diseases as compared to adults. Elderly people are also prone to some diseases that are not so common among young adults. Allergy to drugs also links to age as the allergy increases with age (Soderholm et al., 2018). I concur with you that severe allergic reaction would definitely be a concern
References
Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal
pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). Mosby/Elsevier.
Centers for Disease Control and Prevention. (2021, November 23). Pharyngitis (strep throat): Information for clinicians. Retrieved March 1, 2022, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
Kidney transplant is an effective treatment for patients suffering from end-stage renal disease. However, some patients develop adverse effects including kidney rejection. The management of kidney transplant rejection depends on the type and patient factors. Therefore, this paper examines why a patient with acute kidney transplant developed the described symptoms, genes associated with kidney transplant rejection and process of immunosuppression.
Why the Patient Presented the Symptoms Described
The patient presented symptoms that include gaining weight, decreased urinary output, fatigue, and running temperatures up to 101 F. The patient gained weight because of the increased body fluid volume level. The kidneys excrete excess fluids from the body. Impaired kidney function as seen in the case study affects the regulation of fluids in the body, hence, its accumulation and weight gain. The decline in renal function also impaired normal urine output. This led to reduced urine production, as seen in the case study. The rejection altered the normal renal function in the excretion process, leading to oliguria. The kidneys also eliminate toxins from the body. This includes excess ammonia in urine. Impaired kidney problems affect the elimination of these toxins, which lead to symptoms such as fatigue, poor concentration, acidosis, and anemia. Therefore, this explains the patient’s experience of fatigue. Patients with end-stage renal disease and those with kidney transplant rejection problems also experience immunosuppression (Rauen et al., 2020). This predisposes them to infections, hence, the fever that the patient has.
Genes Associated with the Development of the Disease
Genes have been linked with kidney transplant rejection. They include cytochrome p450 2EI (CYP2EI), CYP3A5, cytotoxic T-lymphocyte associated protein 4 (CTLA4), C-X-C motif chemokine ligand 8 (CXL8), epoxy hydrolase 2, coagulation factor II thrombin, and coagulation factor V genes. In addition, Forkhead box P3, Fc fragment of IgG receptor IIA, major histocompatibility complex class II, I, DO alpha, and interleukin 1 beta, 2, 2-receptor subunit beta genes also play a role in the development of the rejection in kidney transplant. Genes such as interleukin genes are inflammatory cytokines that inhibits inflammatory processes once a person received an allograft. On the other hand, this gene also downgrades the maturation of antigens and cells that develops host’s immunity following the transplant (Arnold et al., 2022; Spicer & Runkel, 2019; van Vugt et al., 2022). Other genes such as ATP-binding genes increase the body’s resistance towards drugs used in suppressing the immune system following the transplant.
Process of Immunosuppression
Immunosuppression refers to the state in which the ability of the body to fight infections is reduced. The immune system is lowered to a level that it cannot counteract any disease causing organisms from invading the body. The causes of immunosuppression include the use of medications that are used in conditions such as cancer. The other cause is conditions that depress the immune system such as cancer and HIV. Treatments for cancer such as radiotherapy and chemotherapy also cause immunosuppression. The effects of immunosuppression are varied. They include increasing the vulnerability of patients to infections. It also increases costs that patients incur due to frequent hospitalizations (Gupta et al., 2021). Prolonged infections also affect the patients’ quality of life. Patients may also die in cases where the immune system is severely compromised.
Conclusion
In conclusion, the patient presented the symptoms because of reduced renal functioning. Genes are involved in the development of kidney transplant rejection. The rejection may result in immunosuppression, which has negative effects on health.
References
Arnold, M.-L., Heinemann, F. M., Oesterreich, S., Wilde, B., Gäckler, A., Goldblatt, D., Spriewald, B. M., Horn, P. A., Witzke, O., & Lindemann, M. (2022). Correlation of Fc Receptor Polymorphisms with Pneumococcal Antibodies in Vaccinated Kidney Transplant Recipients. Vaccines, 10(5), Article 5. https://doi.org/10.3390/vaccines10050725
Gupta, R., Woo, K., & Yi, J. A. (2021). Epidemiology of end-stage kidney disease. Seminars in Vascular Surgery, 34(1), 71–78. https://doi.org/10.1053/j.semvascsurg.2021.02.010
Rauen, T., Wied, S., Fitzner, C., Eitner, F., Sommerer, C., Zeier, M., Otte, B., Panzer, U., Budde, K., Benck, U., Mertens, P. R., Kuhlmann, U., Witzke, O., Gross, O., Vielhauer, V., Mann, J. F. E., Hilgers, R.-D., Floege, J., Floege, J., … Hilgers, R.-D. (2020). After ten years of follow-up, no difference between supportive care plus immunosuppression and supportive care alone in IgA nephropathy. Kidney International, 98(4), 1044–1052. https://doi.org/10.1016/j.kint.2020.04.046
Spicer, P., & Runkel, L. (2019). Costimulatory pathway targets for autoimmune and inflammatory conditions: Clinical successes, failures, and hope for the future. Expert Opinion on Investigational Drugs, 28(2), 99–106. https://doi.org/10.1080/13543784.2019.1557146
van Vugt, L. K., Schagen, M. R., de Weerd, A., Reinders, M. E., de Winter, B. C., & Hesselink, D. A. (2022). Investigational drugs for the treatment of kidney transplant rejection. Expert Opinion on Investigational Drugs, 31(10), 1087–1100. https://doi.org/10.1080/13543784.2022.2130751
Alterations in Cellular Processes
This paper is a case study involving a 27-year-old patient with a history of substance abuse who is found unresponsive by emergency medical services. The patient becomes responsive after being administered naloxone. The essay examines the role of genetics, reasons for patient’s symptoms, physiological response, cells involved, and influence of other characteristics.
Genetics play a role in substance use disorders. For example, opioid use disorder has large risk of being inherited in families. Genes such as OPRM1 variates and A118G also predispose individuals to substance abuse disorder. Individuals of European descent with OPRD1 genes also have high predisposition to opioid use disorder. Additional genes include KCNG2, CNHIH3, KCNC1, RGMA, and APBB2 genes (Crist et al., 2019; Liu et al., 2019).
The patient presented with symptoms such as unresponsiveness due to central nervous system depression by the opiate overdose. The patient became response following the administration of naloxone since its an opiate antagonist that reverses the depressing effects of opiates. The patient reported pain in left hip and forearm because the effects of the opiates had ben reversed, hence, perception of pain. There is also tissue necrosis that may have developed due to poor tissue perfusion from depressed central nervous system, which affected circulation and respiratory system (Parthvi et al., 2019). The patient also developed respiratory acidosis, which increased serum potassium, hence, hyperkalemia and ECG changes.
The cells involved in the patient’s symptoms include mast cells, neutrophils, and macrophages. These cells induce the induction and transition of the pain the patient experience. Adaptive immune cells such as B and T cells also initiate and resolve pain. Characteristics such as age would change my response in this case study (Machelska & Celik, 2020). For example, the elderly patients have low sensitivity to pain stimuli and potentially worse outcomes due to opiate overdose. These changes will affect the treatment interventions.
In summary, substance abuse has genetic predisposition. The patient developed the given symptoms because of the effects of opioid overdose and naloxone. Age would affect the clinical symptoms and management of opiate overdose.
References
Crist, R. C., Reiner, B. C., & Berrettini, W. H. (2019). A review of opioid addiction genetics. Current Opinion in Psychology, 27, 31–35. https://doi.org/10.1016/j.copsyc.2018.07.014
Liu, M., Jiang, Y., Wedow, R., Li, Y., Brazel, D. M., Chen, F., Datta, G., Davila-Velderrain, J., McGuire, D., Tian, C., Zhan, X., Choquet, H., Docherty, A. R., Faul, J. D., Foerster, J. R., Fritsche, L. G., Gabrielsen, M. E., Gordon, S. D., Haessler, J., … Vrieze, S. (2019). Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. Nature Genetics, 51(2), Article 2. https://doi.org/10.1038/s41588-018-0307-5
Machelska, H., & Celik, M. Ö. (2020). Opioid Receptors in Immune and Glial Cells—Implications for Pain Control. Frontiers in Immunology, 11. https://www.frontiersin.org/articles/10.3389/fimmu.2020.00300
Parthvi, R., Agrawal, A., Khanijo, S., Tsegaye, A., & Talwar, A. (2019). Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit. American Journal of Therapeutics, 26(3), e380. https://doi.org/10.1097/MJT.0000000000000681
I appreciate your feedback regarding my post! Looking more into drug-induced anaphylaxis (DIA), a different study also agreed that women are more prone than men. However, the reasoning behind this finding is still being researched, and it was found that though women are more prone, men have higher severity cases (Regateiro, Marques, & Gomes, 2020).
Drugs most commonly involved in anaphylaxis are antibiotics and analgesics. In the US, penicillin reached 40.7% out of a study of 19,836 DIA patients in an 18-year timeframe. Interestingly, this particular study by Regateiro, Marques, & Gomes (2020) mentioned that DIA’s are seen more often in ethnically white people than in other ethnicities.
Co-morbidities that would present an increased risk are cardiovascular diseases (ex., hypotension, and hypoxia) and respiratory diseases (ex., asthma and COPD) (Regateiro, Marques, & Gomes, 2020). Fortunately, DIA’s resulting in death are rare (Regateiro, Marques, & Gomes, 2020).
Reference:
Regateiro, F. S., Marques, M. L., & Gomes, E. R. (2020). Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors. International archives of allergy and immunology, 181(7), 481–487. https://doi.org/10.1159/000507445
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