Multimorbidity and Polypharmacy in Family Physician´s Practice – a Clinical Case
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Iedzīvotāju novecošanās dēļ multimorbiditāte kļūst arvien izplatītāka parādība visā pasaulē. Polifarmācija ir bieži sastopamas multimorbiditātes sekas, jo īpaši gados vecākiem cilvēkiem. Ģimenes ārsti līdz pat 80% ikdienas konsultācijās saskaras ar multimorbīdiem pacientiem, un ir svarīgi izmantot holistisku pieeju pacientu ārstēšanā. Šajā darbā aprakstītais gadījums ir 87 gadus vecs vīrietis no Trøndelagas lauku apvidiem. Viņš vērsās neatliekamās palīdzības nodaļā ar pieaugošu nogurumu, miegainību, polidipsiju un poliūriju. Viņam ilgstoši bija hipertensija, priekškambaru fibrilācija, anēmija, stenokardija, hroniska nieru slimība un hroniski obstruktīvi plaušu traucējumi. Viņam tika diagnosticēta hiperosmolāra hiperglikēmija, kas saistīta ar palielinātu perorālu prednizolona lietošanu ilgākā laika periodā. Atveseļošanās procesu sarežģīja akūts neinfekciozs HOPS saasinājums un komplicēta urīnceļu infekcija. Šī darba mērķis ir izcelt problēmas, kas saistītas ar pacientu ar polifarmāciju un multimorbiditāti ārstēšanu. Nozīmējot ārstēšanu multimorbīdiem pacientiem, vienmēr jāņem vērā iespējamās blakusparādības un zāļu mijiedarbība un jāizvērtē to priekšrocības. Multimorbīdu pacientu ārstēšanai jābūt individuāli pielāgotai, un vienmēr jāņem vērā pacientu vēlmes.
Due to the ageing of the population, multimorbidity is an increasing phenomenon worldwide. Polypharmacy is a common consequence of multimorbidity, especially in the elderly population. General practitioners encounter multimorbid patients in up to 80% of their daily consultations, and a holistic approach to patient management is important. The person reported in this case is an 87-year-old man from the rural areas of Trøndelag. He presented to the emergency department with increasing fatigue, somnolence, polydipsia, and polyuria. He had a long history of hypertension, atrial fibrillation, anemia, angina pectoris, chronic kidney disease, and chronic obstructive pulmonary disorder. He was diagnosed with hyperosmolar hyperglycemia related to increased oral prednisolone intake over a longer period. The recovery process was complicated by acute non-infectious exacerbation of COPD and a complicated urinary tract infection. This case report aims to highlight the challenges in the management of patients with polypharmacy and multimorbidity. When prescribing treatment for multimorbid patients, one should always consider possible side effects and drug interactions and weigh them against the advantages. Treatment of multimorbid patients should be individually tailored and patients' wishes should always be considered.
Due to the ageing of the population, multimorbidity is an increasing phenomenon worldwide. Polypharmacy is a common consequence of multimorbidity, especially in the elderly population. General practitioners encounter multimorbid patients in up to 80% of their daily consultations, and a holistic approach to patient management is important. The person reported in this case is an 87-year-old man from the rural areas of Trøndelag. He presented to the emergency department with increasing fatigue, somnolence, polydipsia, and polyuria. He had a long history of hypertension, atrial fibrillation, anemia, angina pectoris, chronic kidney disease, and chronic obstructive pulmonary disorder. He was diagnosed with hyperosmolar hyperglycemia related to increased oral prednisolone intake over a longer period. The recovery process was complicated by acute non-infectious exacerbation of COPD and a complicated urinary tract infection. This case report aims to highlight the challenges in the management of patients with polypharmacy and multimorbidity. When prescribing treatment for multimorbid patients, one should always consider possible side effects and drug interactions and weigh them against the advantages. Treatment of multimorbid patients should be individually tailored and patients' wishes should always be considered.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
multimorbiditāte, polifarmācija, hiperosmolārā hiperglikēmija, ģimenes ārsts, vājums, zāļu mijiedarbība., multimorbidity, polypharmacy, hyperosmolar hyperglycemia, general practitioner, frailty, drug interactions