What is the summary of this patient encounter?

From the Guidelines

The patient encounter can be summarized as a successful telehealth visit where the provider established a therapeutic relational connection with the patient, addressed her concerns and values, and developed a plan to improve adherence to her disease-modifying therapy for multiple sclerosis. The encounter began with the provider introducing themselves and ensuring a suitable environment for the videoconferencing visit, as discussed in the concept analysis of therapeutic relational connection in telehealth by Duffy et al 1. The provider then took the time to learn about the patient's likes, dislikes, and values, using humor to put her at ease, which is essential in building trust and rapport with patients, especially in communities with mistrust in healthcare providers. Key aspects of the visit included:

• The provider's intentional use of body language to convey empathy and maintain eye contact, allowing the patient to feel comfortable and ask questions.
• The discussion of the patient's values and preferences around taking the disease-modifying therapy, and strategizing ways to improve adherence without feeling ostracized from her community.
• The provider's competency in conducting the telehealth examination, explaining their actions, and providing education on the new medication and importance of follow-up.
• The use of active listening throughout the visit and ensuring all the patient's questions were answered before scheduling a follow-up meeting. As recommended by the patient-centered standards for medically integrated dispensing, all questions posed by the patient regarding her therapy were likely documented in her record 1. Overall, the encounter demonstrates a patient-centered approach to care, prioritizing the patient's needs, values, and preferences to improve her quality of life and treatment outcomes.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Patient Encounter Summary

The patient encounter involves a 49-year-old hypertensive diabetic female who presented with metformin overdose, resulting in refractory lactic acidosis and acute renal failure 2. The patient's condition deteriorated despite aggressive care, including normal saline, sodium bicarbonate, and insulin administration. Continuous veno-venous hemofiltration (CVVH) was initiated, but the patient eventually developed pulseless electrical activity and died 31.5 hours after ingestion.

Key Findings

• The patient ingested 60 tablets of 500 mg metformin and 20 combination tablets of 12.5 mg hydrochlorothiazide/20 mg lisinopril 2
• Metformin-associated lactic acidosis can be precipitated by dehydration and aggravated by the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) 3
• Early diagnosis and treatment of metformin-associated lactic acidosis are crucial for patient outcome, and hemodialysis can be life-saving 3

Clinical Encounter Characteristics

• The clinical encounter involves a dynamic educational approach to enhance students' clinical healthcare skills, including simulation and standardized patient encounters 4
• The direct observation clinical encounter examination (DOCEE) is a reliable and valid method for assessing clinical competence, with good interrater agreement and content validity 5
• Agenda-setting is a collaborative communication strategy used by clinicians to work with patients to elicit, propose, and organize topics to be discussed during the encounter 6

Patient Outcome

• The patient's outcome was fatal, despite aggressive care and CVVH initiation 2
• Metformin concentrations decreased to 97 microg/mL 28 hours after ingestion on CVVH, with a first-order elimination half-life of 11.3 hours 2