From the Guidelines
The patient's elevated blood pressure is the most critical issue that needs to be addressed immediately, as uncontrolled hypertension can lead to severe cardiovascular complications, and she should be advised to take her antihypertensive medication as prescribed. The patient presents with bilateral knee pain for which she previously received injections from an orthopedic specialist, as noted in her history of present illness (HPI) [ 1 ]. She has an outstanding balance of $600 with that provider and plans to follow up after addressing this financial obligation. Today, she is requesting a vitamin B12 injection. Her blood pressure is elevated, which she attributes to not having taken her antihypertensive medication yet today, highlighting the importance of adherence to medication regimens, as emphasized in the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults [ 1 ].
Key points to consider in her HPI include:
- Bilateral knee pain with previous orthopedic intervention
- Outstanding balance with the orthopedic provider
- Request for vitamin B12 injection
- Elevated blood pressure due to potential medication non-adherence
- Importance of addressing lifestyle factors and potential secondary causes of hypertension, as suggested by the prevention, detection, evaluation, and management of high blood pressure in adults guideline [ 1 ]
Given the patient's situation, it is crucial to prioritize her blood pressure management to prevent potential cardiovascular risks, as highlighted by the relationship between blood pressure and risk for fatal and nonfatal stroke, ischemic heart disease, and noncardiac vascular disease [ 1 ]. The patient should be encouraged to adhere to her antihypertensive medication regimen and consider lifestyle modifications to help manage her blood pressure, in line with recommendations for managing resistant hypertension and improving hypertension management [ 1 ]. The request for a vitamin B12 injection should be evaluated based on clinical indication and previous documentation of deficiency.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
History of Present Illness (HPI)
The patient is experiencing bilateral knee pain and has undergone an injection in both knees by an orthopedic specialist. She owes the provider $600 and plans to follow up after the pain has subsided.
Current Symptoms and Requests
- The patient is currently experiencing elevated blood pressure due to not taking her blood pressure medication yet.
- She has requested a B12 injection.
Relevant Medical History
- Bilateral knee pain
- Injection in both knees by an orthopedic specialist
- Outstanding balance of $600 with the provider
- Elevated blood pressure due to non-adherence to blood pressure medication
- Request for B12 injection
Potential Diagnostic Considerations
- Knee pain may be related to various conditions, and a thorough evaluation is necessary to determine the underlying cause 2.
- Elevated blood pressure may be a contributing factor to the patient's overall health, and adherence to medication is crucial 3.
- The patient's request for a B12 injection may be related to a deficiency, and sublingual administration may be a viable option 4.
Next Steps
- Further evaluation of the patient's knee pain and underlying causes
- Monitoring and management of elevated blood pressure
- Consideration of B12 injection, potentially via sublingual administration 4