1. Explain the cause for her low calcium and sodium levels. 2. Explain the cause
ID: 3513518 • Letter: 1
Question
1. Explain the cause for her low calcium and sodium levels. 2. Explain the cause of her anemia. What laboratory test should indicate she is suffering from anemia? 3. Explain the cause of her hypotension. How will her body attempt to establish homeostasis? 4. What type of acid-base disorder has she developed, and how will her body compensate? 5. Explain the cause of her elevated ADH and glucose levels. 6. What is the correlation between her illnesses and the low vitamins (D, K, E, and A), renin, and aldosterone levels? 7. Which hormone would the body elevate in response to her low calcium levels? Why? 8. Explain the physiological reason behind her physical findings (yellowish hint of the skin, sclera, multiple bruises, weakness, and edema). 9. Explain the cause of her abnormal stool and urine sample. 10. What cell does Glisten work on? Explain how this medication is able to stimulate insulin secretion. End-Stage Kidney Disease Sarah, a 63-year-old female with a past medical history significant for diabetes mellitus, cirrhosis, gout, and a 30-pack a year smoking history presents to the emergency room with chest pain revealing pericarditis in the echocardiogram, secondary to recently diagnosed end-stage renal disease. Physical examination reveals yellowish discoloration to the skin and sclera, multiple bruises, 2+ bilateral edema, and weakness lasting more than three weeks. Her medications include Glisten, a new drug for diabetes that causes ATP sensitive potassium channels to close, thereby releasing insulin. Her recent laboratory results are as follows: CBC Sodium 126 mE mmo Red blood cell count 3.9 cells/ul Vitals Blood Pressure 92/64 mmHg Blood Gase CO2 30 mmH Hormone Panel Renin Low ADH Elevated Vit Vit E Low rine and Stool Sample Stool color Stool content Increased Fat Content olorExplanation / Answer
1) Low blood Sodium levels (hyponatremia) may be due to the elevated levels of ADH , which causes more retention of water , this causing the concentration of the Na to be low .
The cause of low calcium levels in the blood is due to the low levels of vitamin D . Vitamin D helps in the absorption of Calcium from the intestines.
2) The cause of anaemia is most probably due to the renal disease . Kidneys release a hormone , erythropoietin, which helps the bone marrow to produce red blood cells . In end stage kidney disease , such as in this lady , the erythropoietin levels are diminished which causes the aneamia.
Also , the person shows signs of liver failure ( yellow skin and sclera) which may suggest hemolytic anemia.
There are many laboratory tests for assessing the anemia-
3) The hypotension in this patient is due to the increased levels of ADH, and decreased levels Renin and Aldosterone .
4) Normal HCO3 level ranges from 22-26mmol/L. Here the level is very low , which suggests there is metabolic acidosis.
The pH is less than 7.35 and HCO3 levels are less , so the decreased CO2 Partial pressure is rather a respiratory compensation for the metabolic acidosis .( If pH >7.35, and HCO3 levels were normal , it would suggest metabolic alkalosis.)
Also , there will be increased absorption of HCO3 in the kidneys.
5) Elevated ADH is may be due to syndrome of inappropriate ADH. It can also be due to the presence of a lung carcinoma , as the patient shows a history of smoking.
There is a history of diabetes mellitus , so glucose levels will be increased due to insulin deficiency.
6)Vitamins - A - low . Vitamin A has functions such as retinol production and also maintaining the skin integrity . Low levels of Vitamin A caused the bruises seen in this patient.
D- low levels of Vitamin D causes hypocalcemia.
K- Vitamin K helps in various functions , such as in clotting cascade and also in buildup of calcium in blood . Therefore low Vitamin K levels may result in hypocalcemia.
E- low Vitamin E can cause weakness and bone problems .
The function of Renin , aldosterone and ADH has been explained above .
7) Low calcium levels in the blood will stimulate the Parathyroid hormone (PTH) . Parathyroid hormone causes the calcium from the bones to be released in the bloodstream, and also increased reabsorption of calcium in the kidney .
8)Yellowish discoloration of skin , sclera - it is suggestive of icterus , which is caused by hyperbilirubinemia ( obstruction of bilirubin secretion) . This suggests liver pathology.
Skin bruises - this may be due to Vitamin A deficiency , because Vitamin A helps in maintaining the integrity of skin.
Weakness - It is due to anemia and decreased Vitamin E .
Edema - It is caused by excessive retention of salt and water in the body . Increased ADH and decreased levels of Renin and Aldosterone can affect these .
9) There is insufficient excretion of the bilirubin from the liver , due to some obstruction .
The normal brown colour of stool is due to an excretory product of bilirubin , called stercobilin , which is metabolised from bilirubin .
The fat in the stool may be also due to the bile obstruction.
The normal yellow colour of urine is due to the urobilinogen , which is also an excretory product of bilirubin , as the bilirubin excretion is decreased , there will be colourless urine .
10) Glisten work on the beta cells of pancrease . Beta cells secrets insulin which increases glucose metabolism . The secretion of insulin is due ionic and electrical events in the beta cell membrane-
In the absence of glucose , membrane potential remains stable (-65mV) . ATP from the glucose metabolism blocks or closes the K+ ion channels in the membrane . Therefore more the glucose , more will be the closure of K+ ion channels.
Decreased permeability of K+ ions in the cell will causes depolarization and opening of voltage gated Ca2+ ion channel opening . This causes an influx of the Ca2+ in the cells . Raised intracytoplasmic Ca2+ levels will in turn cause the exocytosis of insulin secretory granules .
Glisten also works by closing the ATP dependent K+ion channels to close , thereby inducing release of insulin from the beta cells .
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.