Blood Work “Chris. Michelle. You go on... I’ll catch up in a minute.”Mary hid he
ID: 3518557 • Letter: B
Question
Blood Work
“Chris. Michelle. You go on... I’ll catch up in a minute.”Mary hid her fear as she struggled to catch her breath. She had been so excited to go hiking with her children. Chris and Michelle were both home on fall break, and Mary had been looking forward to the family time. But she felt like she was hyperventilating, and now her chest was starting to hurt.
“What, we’ve finally outlasted you on the trails?” Chris joked as he looked over his shoulder. “Mom, are you ok? You look awful.”
“Don’t panic, but I think I need to go to the hospital.”
“Michelle! Go get the car!” Chris yelled ahead.
“Please don’t panic—I just want to get it checked out.”
“Michelle!”
After what seemed like an eternity, they arrived at the hospital. As Chris and Michelle helped their mother into the waiting room, the ER attendant noticed them and ushered the family into a small room. Dr. Rosen promptly took Mary’s medical history and ordered an EKG, chest x-ray, blood tests, and urinalysis. The tests were completed in short order, and about an hour later, Dr. Rosen appeared in the exam room. “Ihave some good news, and a little bad news. The good news is...”
“Dr. Rosen to the ER, Code Blue. Stat!” said the voice on the PA.
“Sorry, that’s my cue. But don’t worry, you’ll be fine...once we get you offof the Topamax®. This might takea while, so I’m leaving your chart. I hope I’ll be back to review the test results with you, but it might besomeone else,” said the doctor as the door swung shut.
“Mom, isn’t Topamax your migraine medicine?” asked Michelle.
“Yes. It was originally designed as an epilepsy treatment, but I take it to prevent those migraines that used toput me in bed all day. How could it be causing this?” Mary wondered out loud.
Chris broke the tension, saying, “These are your records, right? Let’s see what we can figure out.” He flippedopen her chart. On the top of the pile were Mary’s blood test results:
Normal range
Mary’s results*
Hemoglobin (g/dL)
12.0–15.0
12.8
Hematocrit (%)
36–44
37.5
Creatine kinase cardiac isozyme
0–3.9%
1
Creatine kinase MM isozyme
96–100%
99
Creatinine
0.5–1.4
0.9
pH
7.35–7.45
7.31
pCO2
(mmHg)
38–52
18.1
pCO2
(mM)
20–27
9.5
pO2
(mmHg)
70–100
121.0
HCO
3
-
(mM)
19–25
8.9
Glucose (mg/dL)
90–140
112
Dr. Rosen reappeared in the cubicle. “Sorry for the interruption, and for leaving you in suspense. Th e good news is that you did not have a heart attack. But I do think you’re having an unusual reaction to Topamax. It appears to be inhibiting your renal carbonic anhydrase, leading to metabolic acidosis. We’ll be giving you an IV, and you should taper off your Topamax under your family physician’s supervision.” Dr. Rosen checked his pager and said, “Sorry, it’s one of those days. Again, you’ll be all right, and the nurse will be with you shortly to start the IV.” He turned on his heel and left just as quickly as he had appeared.
Explain to Chris what is wrong with his Mom
Explanation / Answer
From the given blood report analysis of the patient in the question, the patient is having metabolic acidosis as the bicarbonate concentration is decreased in the blood. This is due to the side effects of the migraine medication taken by the patient. Topamax or topiramate can cause metabolic acidosis as its side effects. Other side effects of topamax include diarrhoea, vomiting, dizziness etc. The partial pressure of carbon dioxide is also increased in the patient. It is also suggesting of respiratory acidosis. Metabolic acidosis together with respiratory acidosis causes acidemia, a life threatening condition. Sign and symptoms of acidemia includes chest pain, palpitations, hypoxia , head ache, nausea, vomiting and abdominal pain etc. Hyperventilation in the patient is due to respiratory acidosis, as the body tries to remove extra carbon dioxide from the lungs to relieve the symptoms of respiratory acidosis.