12 hours ago, at 10:03 PM
Top of Form
Week 6. Discussion: Alina Pedroso
Patient with Polydipsia and Weight Gain
The non-pharmacologic treatment of the patient should focus on prioritizing weight loss through dietary changes and increased physical exercise. Regarding nutritional education, the healthcare professional should advise FM to reduce his intake of saturated fats while focusing on low-carb diets as a way of averting the worsening of hyperlipidemia and obesity. The American Heart Association (AHA) recommends consuming less than 6% of calories from saturated fats daily (Heileson, 2020). Additionally, FM should start with cardio and aerobic exercises that are not vigorous to avoid joint injuries, since he is almost severely obese as indicated by his BMI of 39.8. AHA recommends a minimum of 150 minutes of exercise weekly, which can be scheduled into 30 minutes of exercise five days a week (Ewens et al., 2022). The preferred low-impact exercises can include walking, cycling, or dancing.
Pharmacological treatment recommendations should help FM to address polydipsia, urinary frequency, hyperlipidemia, and hypertension. The healthcare provider should recommend continued use of 10 mg Lisinopril daily to manage the patient’s hypertension and the risk of related complications, such as stroke and heart attack. Continued use of atorvastatin is also advisable, as it manages FM’s hyperlipidemia. Since FM’s obesity could be the primary causative factor for polydipsia, there is a need for medications controlling blood sugar (Ahmadi & Goldman, 2020). They can include metformin, gliclazide, linagliptin, dapagliflozin, or empagliflozin. Lastly, the patient should discontinue using hydrochlorothiazide as it could be a contributor to urine frequency.
Additional laboratory tests can be carried out to determine if FM is suffering from diabetes insipidus (DI). These assessments include a measure of serum electrolytes and glucose, plasma antidiuretic hormone (ADH) level, urinary specific gravity, and simultaneous plasma and urinary osmolality (Weiner & Vuguin, 2020). DI will be diagnosed if the urinary specific gravity test results in 1.005 or lower and the urine osmolality is lower than 200 mOsm/kg while the random plasm osmolality is 287 mOsm/kg. Such tests are vital to determine DI.
Bottom of Form
Florida National University
February 6, 2022
What nonpharmacologic treatments should be recommended for FM?
According to the case, the patient's symptoms in the past three to four weeks are increased thirst, urinary frequency, and blurred vision. Also, the patient reports having experienced significant weight gain and polydipsia. These symptoms are highly associated with type 2 diabetes. The non-pharmacological treatment to recommend to FM is nutritional intervention. The aim is to lose weight through dietary restrictions and better glycemic control. Another approach to therapy is planned and repetitive physical activity that will minimize body weight, blood pressure, and risk of cardiovascular morbidity. The patient's psychological and social well-being should be analyzed. According to the American Diabetes Association, distress and depression can be related to adverse diabetes outcomes (Raveendran, Chacko, and Pappachan, 2018).
What pharmacologic treatments should be recommended or avoided in FM?
The United States Food and Drug Administration recommended Metformin as the first-line therapy for type 2 diabetes (Pop-Busui et al. 2022). The medicine acts by minimizing glucose production and improving insulin sensitivity. However, possible side effects include nausea, bloating, and diarrhea. Insulin therapy is also a pharmacological intervention when the blood sugar level targets are not met with lifestyle modifications. Alternatively, the patient can receive antihyperglycemic drugs other than insulin (Banaszak, Górna, & Przysławski, 2022). They are suitable for managing glucose levels in the blood. They are effective when combined with other antihyperglycemics. Examples include Tirzepatide exenatide and dulaglutide.
What should additional laboratory tests be recommended to FM?
Various additional laboratory tests should be recommended to FM, such as the A1C test. It measures the average level of blood sugar in the previous three months. A level below 5.7% is normal but higher than 6.5% indicates diabetes (Pop-Busui et al., 2022). Another crucial test is the glucose tolerance test. It measures the level of blood sugar before and after taking glucose. Also, the healthcare provider may check for autoantibodies to accurately diagnose the type of diabetes for the patient. The test will involve taking a blood sample, and if the presence of autoantibodies is confirmed, the patient may have type 1 diabetes.