Question

Marcus Jeffries is a 65-year-old electrician with a history of heart failure and diabetes mellitus type 2, who has been in the hospital for two days due to an exacerbation of COPD. The patient stopped smoking two years ago and has good blood glucose control on metformin/glipizide 500 mg/5mg PO BID. In the hospital, Mr. Jeffries has been taking prednisone 20 mg PO every morning and using an albuterol inhaler, two puffs every four hours. Upon assessment, you note that the patient has developed 2+ edema around his ankles and his weight has increased by three pounds since yesterday. No pulmonary crackles are auscultated. You call the physician and receive an order for HCTZ 25 mg PO mg IV STAT and then daily q AM. The nursing assistant measures the patient’s blood glucose level at 236 mg/dL. Mr. Jeffries is surprised at the results, since his blood glucose levels are usually within the normal range.

1. Considering Mr. Jeffries’ medications, what could be contributing to this elevated blood glucose level?

2. What other laboratory values should be monitored closely at this time?

Answer 1

Prednisone and stress from exacerbation of COPD could contribute to the elevated blood glucose level in Mr. Jeffries. Electrolyte levels and kidney function should be closely monitored.

Step-by-step explanation:

The elevated blood glucose level in Mr. Jeffries could be attributed to the use of prednisone, which is a corticosteroid medication. Corticosteroids like prednisone can cause an increase in blood glucose levels by promoting gluconeogenesis and reducing insulin sensitivity. In addition, stress from being hospitalized and having exacerbation of COPD can also contribute to elevated blood glucose levels.

For the given case, other laboratory values that should be closely monitored include electrolyte levels such as sodium, potassium, and chloride, as well as kidney function tests such as blood urea nitrogen (BUN) and creatinine. This is because Mr. Jeffries is experiencing edema, which may indicate fluid and electrolyte imbalances, and the use of medications like prednisone and HCTZ can affect kidney function.