Question

A 31-year-old female was brought to the emergency room with complaints of severe abdominal pain and some vomiting by her family who reported she has been frequently hallucinogenic over the last week. Her record shows three prior hospital visits with the symptoms of severe abdominal pain and constipation in the last year. Previous routine blood tests and abdominal ultrasound had been normal and her symptoms had settled with pain relief and supportive management. On current examination, there was diffuse abdominal tenderness but no rigidity; systemic examination was unremarkable. Blood was collected for routine tests, as well as urine for dipstick testing. The nurse doing the dipstick testing noticed that it was very dark colored and was surprised when it turned out to be negative for protein, blood, nitrites and bilirubin. The following test results were obtained from a panel screen: K+ Total and differential white cell count were normal. Patient Value Normal Range Na+ 131 mmol/L (135-145) 4.2 mmol/L (3.4-4.9) Urea 3.8 mmol/L (2.5-8.0) Creatinine 89 umol/L (40-130) Adj Calcium 2.35 mmol/L (2.20-2.60) Phosphate 0.9 mmol/L 0.7-1.4) Albumin 40 g/L (35-50) ALT 33 U/L (3-55) Alk Phos 77 U/L (30-130) Bilirubin 8 umol/L (3-23) Amylase 68 U/L (0-100) HCG K3 U/L K<3) a. What clinical test abnormalities can be noted in this patient? b. Based on the patient's symptoms, clinical tests and a physician's diagnosis ruling out other causes of abdominal pain (such as ectopic pregnancy, pancreatitis), what could be a potential cause for the patient's symptoms c. What clinical tests should be conducted? What sample from the patient should be used for the test? d. How can the clinical diagnosis explain the dark coloration of the patient's urine? Best er n he l

Answer 1

a. The blood test shows , patient has Hyponatremia or low levels of Sodium in the blood.

b. The patient symptoms included, Abdominal pain, Vomiting, Hallucinations, Hyponatremia and Dark urine

These symptoms are suggestive of SIADH (Symptom of Inappropriate secretion of Anti Diuretic Hormone) , if the patient's urine output is decreased. For this the urine out put also has to be monitored.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition that causes your body to make too much antidiuretic hormone (ADH). This causes the water retention and decreased elimination of water from the body.

c. ADH test, can measure circulating ADH levels in the blood, and has to be done for the patient. This blood sample is taken for testing this .

Normal values for ADH range from 0-5 picograms per milliliter and higher levels could be the result of SIADH

d. In SIADH, the increased secretion of ADH occurs. Increased ADH (Anti diuretic hormone) cause decrease in diuresis or urination. This cause decreased urine volume and causing the urine to be concentrated and dark.