Dr.Bosnak’s
DRUG DETECTIVES
The Silent Risk
Episode 02
Sebastian, a 19-year-old student, presented to the physician in the morning with severe headache, vomiting, and photophobia since the yesterday. At examination, the patient had a fever and was unable to touch his chin to his knees.
He did not have a rash and was alert and oriented. Physician administered benzylpenicillin intravenously (1200mg), and the patient was transferred urgently by ambulance to hospital. Sebastian weighed 70 kg, was a smoker, and had an unremarkable medical history. He occasionally took caffeine tablets before examinations but did not take regular medication. He recalled receiving a meningitis vaccine at school. Tragically, Sebastian died shortly after arriving at the hospital.
Heart rate: 130 bpm
Temperature: 41.0°C
Respiratory rate: 25 breaths per minute
Blood pressure: 90/60 mmHg
Oxygen saturation: 96%
Cefotaxime i.v. 2 g q.d.s.
Dexamethasone p.o. 10 mg q.d.s
Aciclovir i.v. 700 mg t.d.s.
Paracetamol p.o./p.r. 1 g q.d.s.
Cyclizine i.v. 50 mg t.d.s. p.r.n.
Enoxaparin s.c. 40 mg o.d. (post-lumbar puncture)
An internal hospital incident report from a few weeks prior details a similar patient case involving adverse reactions to a vaccine.
Health history includes mention of previous vaccinations, and notes about potential concerns with efficacy due to the patient's lifestyle factors such as smoking and caffeine intake.
A record of prescribed dosages and timing of medications includes an unexplained adjustment to his treatment plan.
Records show that Sebastian received his last meningitis vaccine several years ago. The last vaccination was given by the health teams who came to the school 3 days ago. Vaccines sent to school from hospital medical supplies inventory.
A review of the hospital's medical supplies reveals discrepancies in the storage and handling of vaccines, particularly in terms of temperature control and expiration dates.
The pharmacy's records indicate that medication regimen was correct. The patient's treatment plan includes several medications to address his condition, but one treatment seems to have unexpected side effects or reactions in light of his recent medical history.
What is your opinion?
Which of the following can cause the patient's death?
A. The patient succumbed to a severe infection unrelated to their treatment.
B. The patient overdosed on a combination of antibiotics and steroids.
C. The patient suffered from a sudden drop in blood pressure due to an unknown cause.
D. The patient was given a meningitis vaccine that was past its expiration date.
E. The patient had an adverse reaction to the standard treatment protocol for meningitis.
F. The patient experienced complications from a recent spinal tap procedure.
G. The patient experienced an allergic reaction to a recent dose of prescribed medication.
H. The patient had a severe reaction to an over-the-counter painkiller.
I. The patient experienced liver toxicity due to an unknown medication interaction.
J. The patient suffered from a heart attack due to an undiagnosed pre-existing condition.
