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ENT Discussion Case

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ENT Discussion Case

In the ER, ag ACNPs or clinicians are bound to encounter patients exhibiting distinct

signs and symptoms. Such patients require immediate medical attention, and it is the Ag ACNP's

or the medical experts in charge's job to establish an accurate diagnosis. This exercise is crucial

because it improves clinical outcomes and prevents long-term implications for patients. Those

incorrectly diagnosed may accidentally transfer an illness to others, experience a deterioration of

their health, prolong their hospital stay, or be forced to seek medical care constantly. The two

differential diagnoses in the presented ENT case of a 49-year-old Caucasian female are drug

allergies and medication-induced angioedema, with the latter being the most likely diagnosis.

Differential Diagnoses

The possible sources of the signs and symptoms exhibited by the 49-year-old Caucasian

female are drug allergies and medication-induced angioedema. A drug allergy is an aberrant

immune system sensitivity to a medicine. Any medication has the potential to cause a drug

allergic reaction ("Drug Allergy," 2020). However, it should be noted that certain medications

are more likely to cause drug allergic reactions than others. The swelling of the tongue can be a

result of a drug allergic reaction. The patient has admitted to taking Augmentin, an antibiotic

meant for her ear infection. Augmentin known side effects are swelling of the tongue making

drug allergy a possible diagnosis. On the other hand, the patient may be experiencing

medication-induced angioedema, considering she takes 10mg of lisinopril daily to treat her

hypertension issues (HTN). Angiotensin-converting enzyme (ACE) is found in lisinopril which

causes inflammation of the lips, tongue, and face (Gutman, 2010). The 49-year-old Caucasian

female may be suffering from drug allergies or medication-induced angioedema.

Final Diagnosis and the Causative Agent

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Medication-induced angioedema is the most likely diagnosis for the 49-year-old

Caucasian female with a new onset of tongue swelling. This swelling is a well-known side effect

of angiotensin-converting enzyme (ACE) inhibitors, especially during the first several months of

treatment. The patient admits to taking lisinopril, a drug that contains ACE inhibitors, to regulate

her high blood pressure. Like many ACE inhibitors, lisinopril softens and expands the blood

vessels, decreasing blood pressure and making it easier for the heart to move blood throughout

the body. However, lisinopril raises angiotensin I and bradykinin concentrations, which are the

main factors in the development of angioedema by promoting dilation and swelling (Al-Hoqani

et al., 2020). Therefore, it is quite likely that the patient's daily dose of 10mg lisinopril is the

cause of the mild swelling of the tongue and pharynx.

The Treatment Plan for the Patient and Rationale for Selected Treatment Option

The main treatment plan for the patient is the discontinuation of lisinopril as the main

medication for her HTN problems. The patient must stop taking lisinopril daily to ensure she

does not experience acute tongue swelling (Al-Hoqani et al., 2020. Once the patient stops taking

lisinopril, she should adopt alternatives to ACE inhibitors that do not increase angiotensin I and

bradykinin amounts, resulting in tongue selling. Although ACE inhibitors are the first-line

treatment for HTN, angiotensin receptor blockers (ARBs) have a comparable effect on blood

pressure but do not induce tongue swelling. Therefore, the best treatment plan is to discontinue

lisinopril intake and adopt ARBs.

Conclusion

Accurate diagnosis is critical for maintaining excellent health outcomes. Definitive

diagnosis necessitates observing signs and symptoms by an Ag ACNP or a health professional to

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develop a differential diagnosis. Following that, the Ag ACNP should evaluate the most likely

diagnosis and implement a treatment plan to enhance the patient's health and well-being.
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References

Al-Hoqani, Z. K., Al-Kiyumi, M. H., Al-Tamemi, S. H., & Al-Mahrezi, A. M. (2020). Unilateral

tongue angioedema induced by angiotensin converting enzyme inhibitor: A case

report. Oman medical journal, 35(1), e92.https:// doi: 10.5001/omj.2020.10

Drug allergy. (2020, October 15). Mayo Clinic. https://www.mayoclinic.org/diseases-

conditions/drug-allergy/symptoms-causes/syc-20371835

Gutman, I. (2010, August 1). Acutely Swollen Tongue in a Middle-Aged Woman. Photo Quiz -

American Family Physician. https://www.aafp.org/afp/2010/0801/p279.html