The relevant medical and pharmacological information the clinician needs

    A 57 year old female presents to the GP with palpitations on and off for 4 months. The patient describes the palpitations as feeling like missed beats, flutters, and a racing heart usually of sudden onset. Her medical/health history reveals that she has hypertension (BP 152/94 mmHg), she is a mild diabetic, and also suffers from gastro-oesophageal reflux disease (GORD). She has a BMI of 38. Her medications include Cilazapril and Hydrochlorothiazide, and Omeprazole. A blood test revealed the following: • Normal ranges are shown in the table between brackets. Test Result FBC (full blood count) Normal TFTs (Thyroid function tests) TSH 3.2 (0.6-4.5) Magnesium 0.68 mmol/l (0.75-1.25 mmol/l) Urea 7.8 mmol/l (3.6-7.1 mmol/l) Creatinine 118 mcmol/l (52.2-91.9 mcmol/l) Random glucose 9.8 mmol/l (3.0-7.8 mmol/l) K+ 3.2 mmol/l (3.5-5.0 mmol/l) Analyse this case using a critical thinking approach as outlined below: • Gather, analyse and interpret the relevant medical and pharmacological information the clinician needs before treating this patient. (Assessment) • What are the relevant assumptions you have about this case, and what investigations would you undertake to confirm these assumptions? Would you check the levels of any other electrolytes? • Devise a care plan - what are the possible interventions/drugs that could be used to treat this patient? Consider the implications and consequences of the possible interventions and devise a ‘complete’ care plan (short & long term).