CASE STUDY 11-3 A 3-year-old girl was admitted with a diagnosis of acute lymphoc

Question

CASE STUDY 11-3 A 3-year-old girl was admitted with a diagnosis of acute lymphocytic leukemia. Her admitting labora- tory data are shown in Case Study Table 11-3.1 After admission, she was treated with packed cells, two units of platelets, IV fluids, and allopurinol. On the second hospital day, chemotherapy was begun, using IV vincristine and prednisone and intrathecal injections of methotrexate, prednisone, and cytosine arabinoside. She was discharged for home care 5 days later. She was continued on prednisone and al- lopurinol at home. She received additional chemotherapy 1 month later (11/1) and again on 11/14. On 12/6, she was readmitted because she had painful sores in her mouth and was unable to eat. Questions 1. How would you explain the significant elevations 2. What two factors are responsible for the normal 3. What is the most likely cause of the abnormally of uric acid on admission? levels of uric acid seen in subsequent admissions? low level of urea nitrogen observed on 12/6? What other laboratory result would be useful to confirm your suspicions CASE STUDY TABLE 11-3.1 LABORATORY RESULTS 10/1 10/2 10/3 10/4 11/14 12/6 6/20 Urea N, mg/dL 12.0154.0 2.0 Creatinine, mg/dL 0.71.0 0.7 Uric acid, mg/dL 12.0 9.2 4.01.9 2.3 WBC, mm 'Indicates test not performed 0.7 3.1 56,300 3,700 2,800 3,700 Creatine In muscle disease such as muscular dystrophy, polio- pH. most ammonia in the blood exists as ammonium io myelitis, hyperthyroidism, and trauma, both plasma cre NH Figure 11-5 shows the pH-dependent equilb atine and urinary creatinine are often elevated. Plasmaium between NH, and NH,. Ammonia is excreted a creatinine concentrations usually are normal in these pa ammonium ion by the kidney and acts to buffer urine tients. Measurement of creatine kinase is used typically the liver in the production of urea. At normal physiologi

Explanation / Answer

1. Reason responsible for the elevation of uric acid are uncontrolled growth of cell and lymphoid progenitor and intracellular components breakdown like nucleic acid.

2. Two reasons are uncontrolled growth of cell and breaking of intracellular components.

3. As, patient kidney ability to filter is decreased in the diseased condition, high level of urea is observed.

Another laboratory test is plain chest radiograph.

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