Analyzing
Are there any similarities or connections between these seven individuals? What questions would you want to ask the families to answer these questions? Hypothesize what you think the issue is and provide your audience with evidence to argue your point of view.
Yes, there are connections and similarities among these seven individuals especially in the manner in which the symptoms show out. All of them exhibited rapid deaths, loss of strength (sought for strength boost by taking Tylenol), confusion, dizziness and indications of possible type of poisoning since majority ate at a BBQ restaurant. The possible questions that I would ask the bereaved families include: Did the individuals behave in a confused manner? Did they exhibit shortness of breath? What characterized their death? Did they complain of headaches, dizziness or vomiting? What was their last environment before their death?
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I hypothesize that this was an issue of hypoxia, that is, suffocation short supply of oxygen to the tissues which was brought about by a characteristic poisoning possibly cyanide. The rationale behind this hypothesis is the characteristic symptoms that surrounded the death of the individuals. Dizziness, vomiting, headache, confusion, rapid breath and bizarre behavior are possible signs associated with cyanide poisoning.
Evaluating and Applying
Which symptoms/lab results do you consider relevant in forming a diagnosis? Conclude which symptoms/lab results are relevant, reflect on the assumptions of their meaning and rank them in priority. Next to each one, defend your decision/rationale.
The three lab tests carried out were relevant since they formed a chain towards the identification of the specific problem. Here is a rationale behind each lab test carried out:
The autopsy lab test
This lab was necessary in order to establish hypoxia as the lead cause of massive cell death due to the malfunctioning of cellular activities mainly respiration. This is further evidenced by the fact that individuals took Tylenol for energy boosts. This test meant further narrowing to the preceding reasons for cellular respiratory failure.
Sub-cellular metabolite analysis lab
This lab test was important to identify the low levels of ATP or energy production via the respiratory cells. This then meant a certain malfunctioning in a certain metabolic pathway which is facilitated primarily by sodium and potassium ions.
Blood test
From the autopsy lab, a further test of blood showed very high contents of sodium (Na+) and Potassium (K+) than normal. This meant a probable chemical poisoning rich in sodium and potassium. This led to the identification of cyanide poisoning.
Evaluating and Applying
G i v en what y ou n o w kn o w about the action of cyanide on cellular r espiration and the key information previously 8 in questions 1 and 2, conclude why the patients died of lack of o xygen and what influenced their blood o xygen le v els to remain normal?
The cyanide ion binds the iron atom cytochrome C oxidase (CcOX) within the mitochondria of the cells. It then acts as an irreversible enzyme inhibitor and prevents the cytochrome oxidase work which is to facilitate the transportation of electrons to oxygen in the electron transport chain of aerobic cellular respiration. With no oxygen then the mitochondria are unable to carry out energy production through the carrier ATP. Thus oxygen remains only in the blood and is lacking within the tissues which require oxygen such as the heart, muscle cells, and nerve cells. Consequently, these cells begin to die in demand for oxygen (Kulkarni & Rivers, 2013) . When a large enough number of cells die, then the individual experiences rapid death.
Creating
Looking back at the information y ou ha v e about the people befo r e they got sick, can y ou suggest a possible sou r ce of the cyanide poisoning? Provide us with your perspective of c ould these deaths have been prevented?
The possible exposure of the individuals to cyanide poisoning was probably from eating food or drinking some water that had been contaminated with cyanide probably from the local BBQ restaurant. It is possible to also have been exposed to cyanide poisoning through fruits and vegetables where cyanide may be found in the form of cyanogenic glycosides. Whenever sugars attach to these compounds through the glycosylation process, they end up forming free hydrogen cyanide which is an equivalent source of cyanide poisoning. The Body is able to detoxify some small amounts of cyanide but high amounts are too lethal for any treatment to occur. The administration of antidotes that detoxify cyanide or bind it could have been administered such as vitamin B12 as a way to prevent the death of the individuals (Borron, 2016).
References
Borron, S. W. (2016). Management of cyanide poisoning. Oxford Medicine Online . doi:10.1093/med/9780199600830.003.0326
Kulkarni, M., & Rivers, C. (2013). Cyanide Poisoning. MedEdPORTAL Publications . doi:10.15766/mep_2374-8265.9641
Samuel, J., & Franklin, C. (n.d.). Hypoxemia and Hypoxia. Common Surgical Diseases , 391-394. doi:10.1007/978-0-387-75246-4_97
