A 32 year old male presents to your office for initial evaluation. He is a busy
ID: 50123 • Letter: A
Question
A 32 year old male presents to your office for initial evaluation. He is a busy systems analyst for a computer manufacturer who travels a lot, and puts in many hours of work with inadequate rest. He is mildly obese but continues to have a poor diet. He eats fatty foods and does not exercise, aside from when he is running late to an appointment. He snacks often on salty foods. For the past two months, he complains of feeling weak, and occasionally experiences light-headedness and dizziness that is accentuated when rising from a supine position. Eventually, his appetite begins to wane and he starts to losing weight. He is having common episodes of diarrhea. His colleagues and friends notice that he looks tan, despite spending little time in the sun. He complains about cold weather and tries to avoid cold climates and temperatures. He is considering relocating to a warmer region.
When attending a meeting in Denver, he presents to the ER complaining of feeling weak; congestion in his head and chest; and severe abdominal, back, and leg pain. His blood pressure is 70/50 mmHG, respiratory rate is 20. Appropriate labs are ordered.
Results:
Sodium= 120 mEq/l
Potassium-6.0 mEq/l
Ratio of serum Na:K= 25:1
Hematocrit= 59
WBC count= 6000
Decreased plasma cortisol and aldosterone
Urine shows increased excretion of Na and decreased excretion of K
Low levels of hydroxycorticosteroids
What might be causing the pain in the abdomen, back, and legs? Why?
The viral infection poses a kind of stress. Why might the patient have such a severe reaction?
How do the abnormal Na and K levels relate to adrenal function?
Explain the reasons for the elevated hematocrit level.
Why would one see this result in the urine if the adrenal gland is malfunctioning?
What is your diagnosis?
What is ACTH?
Explain why the ACTH level remains elevated.
Why would extra salt intake be appropriate following vomiting or diarrhea?
Explanation / Answer
Answer:
Pain in the abdomen can be due to the Pancreatitis or Kidney stones, these are formed in urinary bladder. Due to the stones in the Kidneys, the person may suffer with pain in the lower back and its pain spread to abdomen latter into the groin, finally legs.
The viral infection may lead to loss of the immunity in the body, the temperature in the body will increase. When person suffer with Diarrhea, he may experience low Sodium and Potassium levels, all the body fluids along with ions(K+, Na+) are lost from the body due to Diarrhea.
Elevated levels of the Hematocrit could be due to the excess loss of the body fluids and low availabity of the oxygen in the blood. Excess urine is excreated due to malfunctioning of the Adrenal gland.
ACTH: Adrenocorticotropic hormone
Excess stress, low potassium level, and excess urine Excreatins are dueto the elevations of The ACTH.
Genarally, doctors advice to take excess salt to recuperate the lost pottassium and sodium lost from the body due to diarrhea and vomitings, as K+ and Na+ ions are lost due to vomitings and Diarrhea.
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