Pathophysiology Does this patient require an adjustment in h

Pathophysiology: Does this patient require an adjustment in his daily dose of folate?

CASE STUDY 89 SICKLE CELL ANEMIA For the Disease Summary for this case study see the CD-ROM PATIENT CASE s Chief Complaints My arms and legs hurt a lot more than usual today. The ibuprofen has stopped working and I need something stronger. I may have overdone it at the gym.\" History I.T. is an 18-year-old African American male with sickle cell anemia who presents with a one day history of increasing pain localized to his arms and legs. His pain has not been relieved with 400-mg ibuprofen every 6 hours for the past 24 hours. He rates his current pain inten- sity level as 8 out of 10. He reports that he always seems to have some pain in his arms, legs and back, but the pain intensified approximately 36 hours after a workout at the gym that was more vigorous than usual. \"I know that I shouldn\'t have done that,\" he confesses, \"but the guys needed a 6th player for a game of 3-on-3. And, on top of that, I forgot to take my water bottle to the gym The patient was diagnosed with homozygous Hbs disease at age 11 months. He first pre sented with a severe case of dactylitis at 10% months with significant swelling and pain in both hands and feet. Electrophoresis revealed a hemoglobin proportion of 86.5% Hbs, 11.3% HbF, and 2.2% HbA At age 16 months, the patient was hospitalized with acute sequestration syndrome and splenomegaly, treated, and released. At age 30 months and again at age 34 months, the patient was hospitalized for Streptococcus pneumoniae pneumonia, treated with IV antibi- otics, and released. He also experienced one episode of acute staphylococcal osteomyelitis of the left knee at age 13. Since the age of 3 years, the patient has averaged three painful crises per year but has had as many as 10 attacks in a year. He has experienced chronic low-grade pain in his arms, legs, and back since becoming a teenager but has been able to cope by tak ing ibuprofen when needed. Other medical conditions and surgeries of note include Born with hypospadias, which was surgically corrected at 8 months of age Tonsillectomy as a child

Solution

Yes, dosage of folate can be increased upto 1 mg orally, intramuscularly, subcutaneously once a day. It can be continued until clinical symptoms of folate deficiency and the hematological profile have normalized.