Sarah, a 63 year old female with a past medical history significant for diabetes
ID: 3520112 • Letter: S
Question
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, and 2+ bilateral edema. Sarah reports 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.
Sarah's recent labratory results:
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.
BC Sodium 126 mE Red blood cell count 3.9 cells/ul Vitals Blood Pressure 92/64 mmHg Blood Gase CO2 30 12 mmo Hormone Panel Renin ADH Low Elevated Vitamins Vit E Low rine and Stool Sample Stool color Stool content Increased Fat Content olorExplanation / Answer
Hyponatremia, (low sodium) is generally occurred as a result of dilution due to fluid retention. Sodium is an electrolyte, and it regulate the water presents around the cells. The fluid retention is as a result of reduced kidney function. The low calcium levels are as a result of decreased levels of calcitriol which is synthesized by the kidneys.
Anemia is as a result of insufficient erythropoietin production by the diseased kidney. It can also be as a result of shortened red blood cell survival. Laboratory investigations would include a peripheral blood film and a full hemogram. The patient developed metabolic acidosis because the kidneys are not able to produce enough ammonia in the proximal tubules which is required to excrete endogenous acid into urine in form of ammonium. The body will compensate by physicochemical mineral dissolution. The process helps in buffering the excess hydrogen ions by bone carbonate. The glucose level is elevated because the patient’s response to insulin and glucose utilization is impaired. Anti diuretic hormone is elevated because of the dilution hyponatremia.
The decrease in renin is as a result of decreased production by the diseased kidney. The low vitamins are as a result of a decrease in fat absorption in the gastrointestinal tract. Parathyroid hormone will be elevated in response to low calcium levels. This is because parathyroid hormone increases phosphate excretion and increases serum calcium by increasing renal calcium reabsorption. The yellow discoloration on the skin and sclera is as a result of deposition of pigment metabolites which are also known as urochromes. The multiple bruises are as a result of pruritus caused by phosphate deposition. The edema is as a result of reduced kidney function which causes edema. It also results from albuminuria. Iremia causes weakness. Glisten works on the beta cells of the endocrine pancreas; it causes closure of ATP sensitive potassium channels hence causing insulin release.
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