Dr.Bosnak’s
DRUG DETECTIVES
The Perils of Polypharmacy
Episode 03
A 58-year-old male patient, Mr. RS, was urgently admitted to the hospital after exhibiting severe disorientation, pronounced tremors, and an unstable gait. His medical history reveals longstanding hypertension, type 2 diabetes, and arthritis, all of which he has managed over the years with various prescribed medications.
The patient resides alone and has managed his health conditions independently, but recently noted feeling unusually fatigued and experiencing occasional sleep disturbances. Not long ago, he consulted with a new specialist, who adjusted his regimen by introducing a new pain reliever for his arthritis tramadol at a dosage of 50 mg twice a day. Medical professionals quickly initiate a series of planned investigations to gain further insights into Mr. RS's deteriorating condition.
Despite the medical team's best efforts, Mr. RS's condition deteriorates rapidly, and within 24 hours of admission, he tragically passes away. The circumstances surrounding his sudden decline remain shrouded in mystery, necessitating a thorough investigation to uncover the true cause of his demise. You, Drug Detective, have been called in to investigate this mysterious death. You must begin your work immediately. Good luck to you.
Amlodipine: 5 mg once a day Metformin: 1000 mg twice a day Ibuprofen: 400 mg every 6 hours as needed for arthritis-related pain and inflammation. Simvastatin: 20 mg taken at bedtime to maintain his cholesterol levels within a healthy range.
Amlodipine: 5 mg once a day Metformin: 1000 mg twice a day Ibuprofen: 400 mg every 6 hours as needed for arthritis-related pain and inflammation. Simvastatin: 20 mg taken at bedtime to maintain his cholesterol levels within a healthy range.
Blood tests: Elevated liver enzymes indicating potential hepatic stress, with slightly raised creatinine levels.
Electrolyte panel: Imbalances were noted in sodium and potassium levels.
Blood glucose level: Slightly elevated, but within a range consistent with a diagnosis of type 2 diabetes.
Full blood count: Slight anemia observed, but otherwise unremarkable.
Drug screen: Tramadol levels were higher than expected, pointing to potential overmedication or interaction.
MRI of the brain: No evidence of stroke, hemorrhage, or significant structural abnormalities.
Despite Mr. RS's family history of Alzheimer's disease, his current condition doesn't align with a gradual cognitive decline. His recent symptoms point to a more immediate and acute issue rather than a progressive one.
Mr. RS's symptoms of confusion and tremors could be linked to the complex web of interactions between tramadol and other medications he was taking. Although Mr. RS's diet may have contained higher levels of salt, contributing to elevated blood pressure, it does not explain the sudden neurological complications he experienced, which could have other origins.
Despite Mr. RS's moderate alcohol consumption history, there is no indication that he engaged in recent drinking. Recent Medication Change Simultaneous use of Tramadol and Antihypertensives Simvastatin and Tramadol Interaction While high blood pressure might seem like a common occurrence in a patient with a history of hypertension, the noticeable spike in Mr. RS's readings could hint at deeper complications arising from the mix of medications.
Though fluctuations in electrolytes can occur in patients with hypertension and diabetes, there is no evidence to suggest a significant imbalance in Mr. RS's case, leaving the cause of his severe symptoms unclear.
