Question

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 below. After admission, she was treated by administration of packed red cells, 2 units of platelets, IV fluids, and allopurinol. On the second hospital day, chemother-apy was begun, using IV vincristine and prednisone and intrathecal injections of methotrexate, predni-sone, and cytosine arabinoside. She was discharged for home care 5 days later. She was continued on prednisone and allopurinol 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 of uric acid on admission? 2. Which two factors are responsible for the normal concentrations of uric acid seen in subsequent admissions? 3. Which is the most likely cause of the abnormally low concentration of urea nitrogen observed on 12/6? Which other laboratory test would confirm your suspicions? 10/1 10/2 10/3 10/4 11/14 12/6 6/20 Urea N 12.0 15 4,0 2,0 (mg/dL) Creatinine 0.7 1.0 0.7 0.7 (mg/dL) Uric acid 12.0 9.2 4.0 1.9 2.3 3.1 (mg/dL) 3,700 2,800 WBC 56,300 3,700 (mm3) Indicates test not performed

Answer 1

Answer:

1. Elevated uric acid levels is common in patients with acute lymphocytic leukaemia. It due to the rapid cells turnover and the breakdown of DNA and other intracellular contents.

2. * Allopurinol : It is first line drug used to treat high concentrations of uric acid. Allopurinol is a purine analogue which inhibits xanthine oxidase and decrease the production of uric acid

* Prednisone: It is another choice of drug for the treatment of gout. Prednisone decreases the SUA by increasing  the uric acid clearance.

3. The most likely cause of abnormal low concentration of blood urea nitrogen is the side effects of chemotherapy. Nephrotoxicity is a common side effects of these drugs. These damage leads to the changes in creatine, BUN, and urinary output.

Laboratory tests help to confirm are : BUN test , serum creatinine test, GRF test